Method of surgically reshaping the nasal bone

ABSTRACT

A surgical handpiece adapter for converting rotary motion of a powered surgical handpiece into reciprocating motion to drive a cutting member includes a rear drive shaft for being removably coupled to a rotatable drive shaft of the handpiece, a front drive shaft for being removably coupled to the cutting member and a motion converting mechanism causing reciprocation of the front drive shaft and, therefore, the cutting member coupled thereto, in response to rotation of the rear drive shaft by the drive shaft of the handpiece. A handpiece adapter assembly is formed by an adapter and a cutting member coupled thereto, and a powered surgical handpiece assembly is formed by an adapter, a cutting member coupled to the adapter and a powered surgical handpiece coupled to the adapter. A cutting member includes a surgical suction rasp for being reciprocatively driven to cut anatomical tissue and having a tissue cutting surface and a suction passage with an inlet opening along the tissue cutting surface for removing anatomical debris from an operative site at which the rasp is used. A cutting member includes an osteotome for being reciprocatively power driven to cut anatomical tissue and having a cutting edge and a blunt tip extending distally of the cutting edge. A method of facial surgery includes the steps of reciprocating a distal end of a rasp to reshape the nasal bone of a patient and removing anatomical debris through a suction passage of the rasp while the nasal bone is being reshaped. Another method of facial surgery includes the steps of reciprocating a distal end of an osteotome via a powered surgical handpiece and moving the distal end of the osteotome, while it is being reciprocated, forwardly along the nasal bone of a patient in a predetermined path with a cutting edge of the osteotome in contact with the nasal bone to make a cut of desired length in the nasal bone along the predetermined path.

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

[0001] This application is related to prior patent applications Ser. No.09/005,010, Ser. No. 09/005,012 and Ser. No. 09/005,014 filed Jan. 9,1998, which are divisionals of prior application Ser. No. 08/775,147filed Dec. 31,1996 and now abandoned, and to Ser. No. 09/005,189 filedJan. 9, 1998, which is a continuation of Ser. No. 08/775,147, which is acontinuation-in-part of Ser. No. 08/719,130 filed Sep. 24, 1996 and nowabandoned. The disclosures of all of the foregoing patent applicationsare incorporated herein by reference.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention:

[0003] The present invention generally relates to surgical handpieceadapters for powered surgical handpieces, to cutting members for beingdriven by surgical handpiece adapters, to powered surgical handpieceassemblies and to methods of facial surgery. More particularly, thepresent invention relates to a surgical handpiece adapter by whichrotary motion of a powered surgical handpiece is converted toreciprocating motion, to cutting members for being reciprocativelydriven by a rotary powered surgical handpiece via an adapter, to poweredsurgical handpiece assemblies incorporating a powered surgicalhandpiece, an adapter and a cutting member, to handpiece adapterassemblies incorporating an adapter and a cutting member and to methodsof facial surgery using the same.

[0004] 2. Brief Description of the Prior Art

[0005] Powered surgical handpieces are commonly used in many medicalspecialties to drive cutting members for performing various diversecutting functions. One particularly advantageous reusable, powered ormotorized surgical handpiece is the XPS™ StraightShot handpiece ofXomed, Inc., Jacksonville, Fla., the XPS™ StraightShot handpiece beingthe subject of prior patent applications Ser. No. 09/005,010, Ser. No.09/005,012, Ser. No. 09/005,014 and Ser. No. 09/005,189, all of whichwere filed Jan. 9,1998, Ser. No. 08/775,147 filed Dec. 31,1996 and nowabandoned and Ser. No. 08/719,130 filed Sep. 24, 1996 and now abandoned,the disclosures of all the foregoing patent applications beingincorporated herein by reference. The XPS™ StraightShot handpiece has afront drive shaft rotatably driven by a motor of the handpiece. Thefront drive shaft has drive pins thereon for drivingly engaging prongsdisposed on a proximal end of a blade or cutting member that is to berotatably driven by the handpiece. The blade or cutting member isselectively engageable and disengeable with the front drive shaftallowing the handpiece to be used to rotatably drive a variety of bladesor cutting members selectively coupled therewith. In accordance with thepresent invention, an adapter for the XPS™ StraightShot handpiece isprovided by which the rotary motion of the front drive shaft isconverted to reciprocating motion in order to reciprocatively drive ablade or cutting member.

[0006] Surgical cutting instruments wherein a rotatable output shaft ofa motor, i.e. a driver, is used to reciprocate, via a cam and camfollower, a driven blade or cutting member have been proposed asexemplified by U.S. Pat. No. 4,108,182 to Hartman et al., U.S. Pat. No.4,210,146 to Banco and U.S. Pat. No. 4, 246,902 to Martinez. In priorsurgical cutting instruments wherein rotary motion of the driver isconverted to reciprocating motion of the driven blade or cutting member,the mechanism or structure by which the rotary motion is converted tothe reciprocating motion is an integral, permanently installed part ofthe cutting instrument and cannot be detached or separated therefrom.Accordingly, such prior surgical cutting instruments, of which theforegoing patents are representative, can only be used to reciprocate ablade or cutting member and cannot also be used with blades or cuttingmembers which are to be rotated.

[0007] Various other powered surgical handpieces having motors fordriving removable blades or cutting members have also been proposed, asillustrated by the Stryker Hummer system of Stryker Endoscopy, SanDiego, Calif., the Apex System of Linvatec, Incorporated, Largo, Fla.,the PS 3500 and EP-1 Surgical Drive System of Dyonics, Inc. of Andover,Mass. and the Wizard microdebrider system of Xomed, Inc., Jacksonville,Fla. Such powered surgical handpieces are limited for use with blades orcutting members that are to be rotated and do not include any mechanismor structure by which the powered surgical handpieces can be adapted foruse with blades or cutting members that are to be reciprocated.

[0008] In various surgical procedures, particularly infacial proceduresincluding rhinoplasty and supraorbital reshaping, blades or cuttingmembers such as rasps and/or osteotomes have been used to cut anatomicaltissue such as bone. However, prior to the present invention,reciprocating rasps could not be used with the XPS™ StraightShothandpiece. In addition, prior reciprocating rasps do not have suctionpassages with inlet openings, respectively, disposed on tissue cuttingsurfaces, respectively, of the rasps, by which anatomical debris iswithdrawn or removed from operative sites at which the rasps are used.Conventional osteotomes have been used in facial surgery to make medialand lateral cuts in the nasal bone of a patient during rhinoplasty.Conventional osteotomes are manually tapped into and/or along the nasalbone, via a mallet applied to proximal ends of the osteotomes, in orderto make the required cuts. The latter process is tedious and timeconsuming, which places the patient at increased risk of complications.Furthermore, manual tapping in of conventional osteotomes is greatlysubject to human error and increases the risk of unsatisfactory results,such that the results obtained with surgery are greatly dependent on theindividual skill of the surgeon. Accordingly, it would be desirable toreciprocatively drive an osteotome with a powered surgical handpiece inorder to enhance the quality of cuts made therewith, to reduce the timerequired to execute such cuts and to facilitate accomplishment ofsatisfactory results by surgeons of varying degrees of skill. It wouldalso be desirable for various types of rasps and osteotomes to bereciprocated, via a removable adapter, by an XPS™ StraightShot handpiecewhich, when the adapter is removed therefrom, can also be used torotatably drive rotatable blades or cutting members.

SUMMARY OF THE INVENTION

[0009] Accordingly, it is a primary object of the present invention toovercome the aforementioned limitations or disadvantages of priorpowered surgical handpieces, rasps, osteotomes and methods of facialsurgery.

[0010] Another object of the present invention is to adapt a poweredsurgical handpiece, having a rotatable driver, to reciprocatively drivea blade or cutting member removably coupled to the handpiece.

[0011] Yet another object of the present invention is to adapt the XPS™StraightShot handpiece to reciprocatively drive a blade or cuttingmember.

[0012] A further object of the present invention is to provide aremovable adapter for a powered surgical handpiece by which rotarymotion of a drive shaft of the handpiece is converted to reciprocatingmotion, via the removable adapter, to reciprocatively drive a blade orcutting member removably coupled to the adapter.

[0013] A still further object of the present invention is to provide aremovable adapter for the XPS™ StraightShot handpiece by which thehandpiece is capable of being used to reciprocatively drive a blade orcutting member when the adapter is coupled with the handpiece and, whenthe adapter is removed from the handpiece, is capable of rotatablydriving a blade or cutting member.

[0014] An additional object of the present invention is to provide asurgical rasp having a suction passage with an inlet opening on a tissuecutting surface of the rasp by which debris is withdrawn or removed froman operative site at which the rasp is used to cut anatomical tissue.

[0015] It is also an object of the present invention to reciprocativelydrive a surgical rasp via the XPS™ StraightShot handpiece.

[0016] The present invention has as another object to reciprocativelydrive an osteotome via a powered surgical handpiece.

[0017] Additionally, it is an object of the present invention tofacilitate the performance of surgical facial procedures, particularlyrhinoplasty and supraorbital procedures.

[0018] Some of the advantages of the present invention are that variousreciprocatively moveable blades or cutting members can be used with asingle adapter and handpiece, a single handpiece can be used to driveboth rotatable and reciprocative blades or cutting members, varioussizes of adapters can be provided in accordance with the strokes desiredfor the blades or cutting members and/or the forces exerted thereon bythe blades or cutting members, the adapter can be designed with aparticular stroke, a plurality of adapters can be provided with eachadapter having a different stroke, a single handpiece can be used withvarious sizes of adapters, the handpiece and the adapters can bereusable while the blades or cutting members can be disposable forsingle patient use, the blades or cutting members can be reciprocated atvarious speeds in accordance with the speed selected for the motor ofthe handpiece, anatomical tissue can be cut by a rasp whilesimultaneously removing anatomical debris via a suction passage of therasp, anatomical debris is removed from the operative site via thesuction passage to a location external of the patient's body, the raspcan be designed with a curve or arc corresponding to the naturalcurvature of the human head from behind the eyebrow to the hairline forparticularly advantageous use in supraorbital procedures, the tissuecutting surface of the rasp can be designed with various degrees ofcoarseness, the need for manually tapping in osteotomes duringrhinoplasty is eliminated, the time required to cut bone during facialprocedures is greatly reduced, the rasps and osteotomes can be used withvarious adapters and/or powered surgical handpieces, includingconventional adapters and/or conventional powered surgical handpieces,and the rasps and osteotomes are particularly suited for use inminimally invasive surgical procedures.

[0019] These and other objects, advantages and benefits are achievedwith the subject invention as generally categorized in a surgicalhandpiece adapter for converting rotary motion of a powered surgicalhandpiece into reciprocating motion for reciprocatively driving a bladeor cutting member. The adapter includes a rear drive shaft having aproximal end for being removably coupled to a drive shaft of thehandpiece and having a distal end, a front drive shaft having a distalend for being removably coupled to the cutting member and a motionconverting mechanism by which rotation of the rear drive shaft by thedrive shaft of the handpiece is converted to reciprocating motion of thefront drive shaft and, therefore, the cutting member coupled therewith.The motion converting mechanism includes a cam at the distal end of therear drive shaft and a cam follower on the front drive shaft inengagement with the cam. The cam causes reciprocation of the camfollower and, therefore, the front drive shaft, when the rear driveshaft is rotated.

[0020] A surgical handpiece adapter assembly is formed by the adapterand a cutting member coupled thereto. In one embodiment, the cuttingmember has a proximal end adapted to drivingly engage the distal end ofthe front drive shaft of the adapter when the cutting member is in aspecific orientation relative to the adapter. In another embodiment, thecutting member has a groove for receiving a locking member of theadapter. A powered surgical handpiece assembly is formed by the adaptercoupled to a powered surgical handpiece and to a cutting member. In oneembodiment, the proximal end of the rear drive shaft of the adapter isadapted to drivingly engage the drive shaft of the handpiece when thecutting member is in a specific orientation relative to the handpiece,the specific orientation corresponding to the preferred orientation foruse of the cutting member when the handpiece is manually grasped or heldby a surgeon in the normal manner. Various types of cutting members,including rasps and osteotomes, may be used in a surgical handpieceadapter assembly and/or a powered surgical handpiece assemblyincorporating the adapter of the present invention to be reciprocativelydriven via the adapter to cut anatomical tissue including bone.

[0021] A surgical suction rasp according to the present inventionincludes an elongate member having a distal end and a proximal end, atissue cutting surface at the distal end of the elongate member and asuction passage having an inlet along the tissue cutting surface and anoutlet disposed proximally of the distal end of the elongate member. Theproximal end of the rasp is adapted to be coupled with a drive shaft forreciprocating the distal end of the rasp to cut anatomical tissue withthe tissue cutting surface while anatomical debris is removed throughthe suction passage. The rasp may be assembled to an adapter, such asthe adapter of the present invention, to form a surgical handpieceadapter assembly. The rasp may be assembled to an adapter and to apowered surgical handpiece to form a powered surgical handpieceassembly.

[0022] Another surgical handpiece adapter assembly according to thepresent invention includes an osteotome coupled with an adapter capableof reciprocating the osteotome in response to the adapter beingrotatably driven. Another powered surgical handpiece assembly accordingto the present invention includes an osteotome coupled with an adapterwhich, in turn, is coupled with a powered surgical handpiece. Theadapter is capable of reciprocating the osteotome in response to theadapter being rotatably driven by the handpiece.

[0023] A method of facial surgery according to the present inventionwherein the nasal bone of a patient is surgically reshaped includes thesteps of introducing a distal end of a surgical suction rasp through anincision in the patient's nose, advancing the rasp along the nose toposition the distal end at an operative site at which an area of thenasal bone is to be reshaped, positioning a tissue cutting surface atthe distal end of the rasp in contact with the area of the nasal bonethat is to be reshaped, reciprocating the distal end of the rasp toabrade and thusly reshape the nasal bone with the tissue cuttingsurface, and removing anatomical debris from the operative site througha suction passage of the rasp while the nasal bone is being reshaped.

[0024] A method of facial surgery according to the present inventionwherein a cut is made in the nasal bone of a patient includes the stepsof introducing a distal end of an osteotome through an incision in thepatient's nose, positioning a cutting edge on the distal end of theosteotome at a location on the nasal bone at which a cut is to be made,reciprocating the distal end of the osteotome via a powered surgicalhandpiece, moving the distal end of the osteotome, while it is beingreciprocated, forwardly along the bone in a predetermined path with thecutting edge in contact with the nasal bone to make a cut of desiredlength in the nasal bone along the predetermined path.

[0025] Other objects and advantages of the present invention will becomeapparent from the following description of the preferred embodimentstaken in conjunction with the accompanying drawings, wherein like partsin each of the several figures are identified by the same referencecharacters.

BRIEF DESCRIPTION OF THE DRAWINGS

[0026]FIG. 1 is an exploded perspective view of a powered surgicalhandpiece assembly according to the present invention illustratingassembly of a surgical handpiece adapter to a powered surgical handpieceand to a blade or cutting member to be driven by the handpiece via theadapter.

[0027]FIG. 2 is a side view, partly in section, of the surgicalhandpiece adapter according to the present invention.

[0028]FIG. 3 is a distal end view of a front drive shaft of the surgicalhandpiece adapter.

[0029]FIG. 4 is a sectional view taken along line 4-4 of FIG. 2.

[0030]FIG. 5 is a proximal end view of a distal housing member of thesurgical handpiece adapter.

[0031]FIG. 6 is a top view of a cam of the surgical handpiece adapter.

[0032]FIG. 7 is a side view of an alternative cam for the surgicalhandpiece adapter.

[0033]FIG. 8 is a side view of a cutting member, which is a surgicalsuction rasp, according to the present invention.

[0034]FIG. 9 is a bottom view of the rasp of FIG. 8.

[0035]FIG. 10 is a side view of an alternative surgical suction raspaccording to the present invention.

[0036]FIG. 11 is a side view of the cutting member, which is anosteotome, of FIG. 1.

[0037]FIG. 12 is a bottom view of the osteotome.

[0038]FIG. 13 is a bottom view of an alternative osteotome for use withthe surgical handpiece adapter.

[0039]FIG. 14 is a perspective view illustrating use of the rasp of FIG.8 to reshape the nasal bone of a patient in a facial procedure.

[0040]FIG. 15 is a perspective view illustrating use of the osteotome ofFIGS. 1, 11 and 12 to make a straight medial cut in the nasal bone of apatient in a rhinoplasty procedure.

[0041]FIG. 16 is a perspective view illustrating use of the osteotome ofFIG. 13 to make a curved lateral cut in the nasal bone of a patient in arhinoplasty procedure.

[0042]FIG. 17 is a perspective view illustrating use of the rasp of FIG.10 in a supraorbital procedure.

[0043]FIG. 18 is a broken side view, partly in section, of a distalportion of an alternative surgical handpiece adapter according to thepresent invention.

[0044]FIG. 19 is a bottom view of a further alternative rasp accordingto the present invention adapted for use with the adapter of FIG. 18.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0045] A powered surgical handpiece assembly according to the presentinvention is illustrated in FIG. 1 and includes a powered surgicalhandpiece, a surgical handpiece adapter removably coupled to thehandpiece and a blade or cutting member removably coupled to the adapterfor being driven by the handpiece via the adapter. A surgical handpieceadapter or converter 10 of the powered surgical handpiece assembly isillustrated in FIGS. 1 and 2. The surgical handpiece adapter 10according to the present invention includes a front drive shaft 12, arear drive shaft 14 for being rotatably driven by the powered surgicalhandpiece 16 and a motion converting mechanism 18 for converting ortransforming rotary motion of the rear drive shaft 14 into reciprocatingmotion of the front drive shaft 12. The front drive shaft 12, which ispreferably made of 17-4 PH stainless steel having a hardness of H900,includes a distal or forward section 20, a distal or forwardintermediate section 22, a proximal or rearward intermediate section 24and a proximal or rearward section 26. The distal section 20 is formedor provided as a collet 20 including a cylindrical proximal or rearwardportion 28 extending distally from the distal intermediate section 22, atruncated conical proximal or rearward intermediate portion 29 extendingdistally from the proximal portion 28, a cylindrical distal or forwardintermediate portion 30 extending distally from the proximalintermediate section 29 and a truncated conical distal or forwardportion 31 extending distally from the distal intermediate portion 30.

[0046] The proximal portion 28, the proximal intermediate portion 29,the distal intermediate portion 30 and the distal portion 31 are inlongitudinal, coaxial alignment, and a longitudinal passage or boresection 32 extends entirely through the distal section 20. The proximalportion 28 and the distal intermediate portion 30 are of constant oruniform cross-section or external diameter along their lengths,respectively, and the external diameters of the proximal portion 28 andthe distal intermediate portion 30 are the same or substantially thesame. The proximal intermediate portion 29 is of non-constant ornon-uniform cross-section or external diameter along its length and hasa minimum external diameter joined to or merging with the distalintermediate portion 30 and a maximum external diameter, greater thanthe external diameters of the proximal portion 28 and the distalintermediate portion 30, defining a transverse shoulder at which theproximal intermediate portion 29 is joined to the proximal portion 28.The distal portion 31 is also of non-constant or non-uniformcross-section or external diameter along its length and has a minimumexternal diameter at a transverse surface defining a distal end of theadapter 10 and a maximum external diameter, greater than the externaldiameters of the proximal portion 28 and the distal intermediate portion30, defining a transverse shoulder at which the distal portion 31 isjoined to the distal intermediate portion 30. The maximum externaldiameter of the distal portion 31 is smaller or less than the maximumexternal diameter of the proximal intermediate portion 29. Thelongitudinal passage section 32 is of uniform or constant diameter orcross-section along the entire length of the distal section 20.

[0047] As shown in FIGS. 2 and 3, a plurality of longitudinallyextending gaps 33 are formed in the wall of distal section 20, and thegaps 33 extend the entire length of the distal section 20. In the caseof front drive shaft 12, four gaps 33 are provided in the distal section20 at 90 degree spaced locations about a central longitudinal axis ofthe distal section 20, which is coaxial with a central longitudinal axisof the front drive shaft 12 and with a central longitudinal axis of theadapter 10. In this manner, four longitudinally extending legs aredefined by the wall of distal section 20. Each gap 33 has a widthbetween opposing gap edges 34 of adjacent legs, and the gap width is ofa first or maximum size when the collet 20 is open as shown in FIGS. 2and 3. With the collet 20 open, the maximum widths of the gaps 33 arethe same or substantially the same, and the gap widths are uniform orconstant along the length of the distal section 20.

[0048] The distal intermediate section 22 is coaxial with the distalsection 20 and has a cylindrical rearward or proximal portion mergingwith a truncated conical or tapered distal or forward portion, which isjoined to or merges with the proximal portion 28 of distal section 20.An external thread 35 is disposed on the cylindrical portion of thedistal intermediate section 22 and extends the entire length of suchcylindrical portion. The external thread 35 defines a maximum externaldiameter for distal intermediate section 22 which is larger or greaterthan the maximum external diameter of proximal intermediate portion 29of distal section 20. A longitudinal passage or bore section 36 extendsentirely through the distal intermediate section 22 and is continuouswith passage section 32 of distal section 20. The passage section 36 hasa diameter or cross-section, which is uniform or constant along theentire length of distal intermediate section 22, that is the same as thediameter or cross-section of passage section 32.

[0049] An operating member in the form of a nut 38 is disposed on thefront drive shaft 12 and is threadedly engaged with the thread 35 ofdistal intermediate section 22 as shown in FIG. 2. The nut 38 has acylindrical rearward or proximal section and a truncated conical distalor forward section extending distally from the rearward section thereof.A longitudinal passage extends entirely through nut 38 and includes acylindrical longitudinal passage section 39 disposed in the cylindricalproximal section of nut 38 and a tapered or truncated conicallongitudinal passage section 40 disposed in the truncated conical distalsection of nut 38. The nut 38 is internally threaded as shown by athread 41 disposed within and along the cylindrical longitudinal passagesection 39. The thread 41 extends along the entire length of thecylindrical longitudinal passage section 39, except for a relativelysmall, unthreaded proximal length segment of passage section 39. Thethread 41 corresponds to the external thread 35 on the distalintermediate section 22 of the front drive shaft 12 and is designed forthreaded engagement therewith as shown in FIG. 2. Engagement of thread41 with the thread 35 allows the nut 38 to be moved longitudinally,proximally and distally, relative to and along the front drive shaft 12via rotation of nut 38 relative to the drive shaft 12. All or part ofthe external surface of nut 38 can be knurled, as shown in FIG. 1, orotherwise finished or configured to facilitate grasping and, therefore,operation thereof.

[0050] When the nut 38 is in a distal longitudinal position relative tothe front drive shaft 12 as shown in FIG. 2, the collet 20 is open andthe passage 46 is open so as to allow a proximal end of a blade orcutting member to be inserted therein. A distal most end surface of thetruncated conical distal section of nut 38 is close to or in engagementor abutment with the transverse shoulder of distal portion 31 of frontdrive shaft 12. The shoulder of distal portion 31 prevents removal ofnut 38 from the drive shaft 12. The truncated conical distal section ofnut 38 has an angled interior surface in contact or engagement with amore steeply angled exterior surface of proximal intermediate portion 29of front drive shaft 12 as shown in FIG. 2, the proximal intermediateportion 29 being disposed within the tapered longitudinal passagesection 40 of nut 38. When the nut 38 is moved longitudinally,proximally relative to and along the front drive shaft 12, in responseto rotation of nut 38 in a first rotational direction relative to frontdrive shaft 12, the angled interior surface slides along the exteriorsurface of proximal intermediate portion 29 and forces or moves the legsof collet 20 radially inwardly in the direction of the centrallongitudinal axis of front drive shaft 12. In this manner, the gap edges34 of each gap 33 are moved closer to or into contact with one anotherto reduce the width of gaps 33 and thereby place the collet in a closedposition. In the closed position, the passage 46 is closed so as toprevent passage of a proximal end of a blade or cutting membertherethrough.

[0051] A proximal end of a blade or cutting member can be disposedwithin the passage section 32 when the collet is open and will beforcefully engaged by the legs of the collet as the collet is closed.Upon sufficient longitudinal, proximal movement of nut 38 relative toand along the front drive shaft 12, the nut 38 will be in a proximallongitudinal position, relative to the front drive shaft 12, whereinsufficient force is exerted by the legs upon the blade or cutting memberto firmly couple or secure the blade or cutting member to the frontdrive shaft and prevent removal of the blade or cutting member from thefront drive shaft during use. Accordingly, the proximal longitudinalposition of nut 38 corresponds to the closed position for the collet 20wherein the blade or cutting member is secured or locked onto the frontdrive shaft 12. Removal or detachment of the blade or cutting memberfrom the front drive shaft 12 and, therefore, from the adapter 10, iseffected by untightening the collet, i.e. by rotating the nut 38 in asecond rotational direction, opposite the first rotational direction,relative to front drive shaft 12 to effect longitudinal, distal movementof the nut 38 relative to and along the front drive shaft 12. In thismanner, the nut 38 is placed in the distal longitudinal positioncorresponding to the open position for the collet 20 wherein the legsare permitted to move radically outwardly to allow the proximal end ofthe blade or cutting member to be withdrawn from the passage of thefront drive shaft.

[0052] The proximal intermediate section 24 is coaxial with the distalintermediate section 22 and is of cylindrical configuration having anexternal diameter that is the same or substantially the same as themaximum external diameter of distal intermediate section 22. Alongitudinal passage or bore section 44 extends part way into theproximal intermediate section 24, the passage section 44 beingcontinuous with the passage section 36 and having the same diameter aspassage section 36. The passage section 44 terminates in the proximalintermediate section 24 at a tapered end surface as shown in FIG. 2. Thelongitudinal passage sections 32, 36 and 44 together define acontinuous, unitary, longitudinal passage or bore 46 in the front driveshaft 12, the passage 46 being coaxially aligned with the centrallongitudinal axis of the front drive shaft. The passage 46 extendslongitudinally in the front drive shaft 12 from an open distal end ofdistal portion 31, which defines the distal end of the adapter, to theend surface within the proximal intermediate section 24.

[0053] As shown in dotted lines in FIG. 2, an alignment member 48 isdisposed in the passage 46 distally of the end surface thereof. Thealignment member 48 includes a post, pin or peg extending in atransverse direction in passage section 44, the alignment member 48being disposed perpendicular to the central longitudinal axis of thefront drive shaft 12. The alignment member 48 may comprise a single,unitary post, pin or peg extending diametrically within the passagesection 44 and having opposing ends secured to the wall of front driveshaft 12 forming proximal intermediate section 24. As another example,the alignment member 48 may comprise a pair of individual post, pin orpeg segments having first ends, respectively, secured to the wall offront drive shaft 12 forming the proximal intermediate section 24 andsecond ends terminating within the passage section 44 adjacent or inabutment with one another with the individual post, pin or peg segmentsbeing aligned with one another in the transverse diametric direction.The alignment member 48 facilitates proper alignment or positioning ofthe proximal end of a blade or cutting member within the passage 46 forsecurement of the blade or cutting member to the adapter 10 in aspecific orientation as explained further below.

[0054] A plurality of longitudinally extending, partial sphericalgrooves 50 are formed on an exterior surface of the proximalintermediate section 24 as shown in FIGS. 2 and 4. The grooves 50 havedistal ends disposed proximally of the alignment member 48 and proximalends disposed distally of proximal section 26. The grooves 50 areparallel to the central longitudinal axis of the front drive shaft 12and are disposed at spaced, radial locations about the centrallongitudinal axis of the front drive shaft 12 as shown in FIG. 4. In thecase of front drive shaft 12, six grooves 50 are provided on theproximal intermediate section 24 at 60 degree spaced, radial locationsabout the central longitudinal axis of the front drive shaft 12. Eachgroove 50 is defined by a concave external surface of proximalintermediate section 24 as shown in FIG. 4.

[0055] The proximal section 26 of front drive shaft 12 is coaxial withthe proximal intermediate section 24 and has an external cylindricalconfiguration with a uniform or constant external diameter that isgreater or larger than the external diameter of proximal intermediatesection 24. A cylindrical recess 54 is formed in the proximal section 26concentric therewith. The recess 54 has a length between an openproximal end of proximal section 26, which defines a proximal end offront drive shaft 12, and a planar end surface 55 within proximalsection 26. The recess 54 is of uniform or constant diameter, and acylindrical aperture or hole 56 is formed in proximal section 26 incommunication with the recess 54 as shown in FIG. 2. In particular, theaperture 56 is formed in the wall of front drive shaft 12 formingproximal section 26 and is located near the open proximal end thereof.The aperture 56 is internally threaded and extends entirely through thewall of front drive shaft 12 in a direction transverse or perpendicularto the central longitudinal axis of front drive shaft 12 and therefore,the central longitudinal axis of adapter 10.

[0056] The proximal end of front drive shaft 12 is disposed within ahousing 57 of adapter 10, the housing 57 including a proximal housingmember or body 58 and a distal housing member or nose 60 connected tobody 58. The body 58, which is preferably made of 17-4 PH stainlesssteel having a hardness of H900, includes a cylindrical distal section62 and a proximal section 63 extending longitudinally, proximally fromthe cylindrical distal section 62. The cylindrical distal section 62 hasa uniform or constant external diameter larger or greater than a uniformor constant external diameter of a cylindrical distal segment ofproximal section 63 such that the cylindrical distal section 62 isjoined to the cylindrical distal segment of proximal section 63 by atransverse shoulder of body 58. A cylindrical recess 64 isconcentrically disposed in the cylindrical distal section 62 and has alength extending proximally from an open distal end of cylindricaldistal section 62 to an interior surface of the transverse shoulder ofbody 58. The length of recess 64 is greater than the length of proximalsection 26, thusly providing room in housing 57 for the front driveshaft 12 to reciprocate or move longitudinally, proximally and distallyrelative thereto. The recess 64 has a uniform or constant diameter of asize to closely receive the external diameter of proximal section 26while allowing the proximal section 26 and, therefore, the front driveshaft 12, to reciprocate or move longitudinally, proximally anddistally, within the recess 64. The proximal section 63 is coaxiallyaligned with the cylindrical distal section 62 and has a longitudinalpassage or bore 65 extending therethrough. The bore 65 is longitudinallyor axially aligned with the recess 64 and has a distal end incommunication with the recess 64 and a proximal end defining an openproximal end of the body 58, which also defines a proximal end of thehousing 57. The bore 65 is of uniform or constant diameter, which issmaller or less than the diameter of recess 64.

[0057] An annular flange 66 is concentrically disposed externally on theproximal section 63, and a plurality of partial spherical recesses 67are disposed on an external surface of flange 66. In the case of body58, the flange 66 is located between the cylindrical distal section 62and the open proximal end of the body 58 and is slightly closer to theproximal end of body 58 than to the cylindrical distal section 62. Acylindrical proximal segment of proximal section 63 extends proximallyof flange 66 and has a uniform or constant external diameter that isslightly greater than the external diameter of the distal segment ofproximal section 63 but less than the external diameter of distalsection 62. The distal and proximal segments of proximal section 63 arein coaxial alignment, and the flange 66 has an external diameter greaterthan the external diameter of the proximal segment of proximal section63 but less than external diameter of distal section 62. Twelve recesses67 are provided on flange 66 at 30° spaced, radial locations about acentral longitudinal axis of body 58, which is coaxial with the centrallongitudinal axis of drive shaft 12 when the drive shaft 12 is assembledto the housing 57. The flange 66 is designed to permit the adapter 10 tobe releasably coupled with a powered surgical handpiece and, inparticular, with the XPS™ StraightShot handpiece as explained furtherbelow. A plurality of tapered holes 69, only one of which is visible inFIG. 2, are formed through the wall of body 58 forming the cylindricaldistal section 62. The holes 69 are disposed adjacent or close to theopen distal end of distal section 62 and extend entirely through thewall of body 58 to communicate with recess 64. In the case of body 58,three holes 69 are provided at 1200 spaced locations about the centrallongitudinal axis of body 58 with the holes 69 being inwardly taperingin a radial direction toward the central longitudinal axis of body 58.

[0058] The nose 60 is preferably made of 17-4 PH stainless steel havinga hardness of H900 and includes a cylindrical intermediate section 72, atruncated conical distal section 73 and a cylindrical proximal section74. The cylindrical intermediate section 72 has a uniform or constantexternal diameter that is the same as the external diameter ofcylindrical distal section 62, and the cylindrical proximal section 74has a uniform or constant external diameter smaller or less than theexternal diameter of cylindrical intermediate section 72 such that atransverse shoulder is formed or defined on nose 60 where thecylindrical proximal section 74 is joined to the cylindricalintermediate section 72. The external diameter of cylindrical proximalsection 74 corresponds to the diameter of recess 64 whereby thecylindrical proximal section 74 can be closely received within therecess 64 with the shoulder of nose 60 in abutment with the distal endof body 58 as shown in FIG. 2. The truncated conical distal section 73extends distally from the cylindrical intermediate section 72 and has anon-uniform or non-constant external diameter with a maximum externaldiameter joined to or merging with cylindrical intermediate section 72and a minimum external diameter at a distal end of nose 60. A shallowcylindrical recess is formed in the distal end of nose 60 incommunication with a longitudinal cylindrical bore 75 extending throughthe nose 60.

[0059] As shown in FIGS. 2 and 5, a plurality of apertures 76,corresponding in number to the holes 69, are formed in the wall of nose60 forming cylindrical proximal section 74. The apertures 76 extendentirely through the wall of nose 60 and thusly communicate with thebore 75. In the case of nose 60, three apertures 76 are provided in nose60 at 120° spaced locations about a central longitudinal axis of nose60; and, when the proximal section 74 of nose 60 is disposed in recess64 with the shoulder of nose 60 in abutment with the distal end of body58, the apertures 76 are in alignment with the holes 69 as shown in FIG.2. Preferably, each of the apertures 76 is tapped to receive a screwinserted therein via the holes 69 aligned therewith.

[0060] The bore 75 has a uniform or constant diameter of a sizesufficiently large to accommodate the external diameter of proximalintermediate section 24 of front drive shaft 12. A plurality of partialspherical grooves 77 are formed in an inner surface of nose 60 definingthe bore 75 as shown in FIGS. 2, 4 and 5, and the grooves 77 extendalong the entire length of bore 75, except for a small distal lengthsegment of bore 75 defining the shallow recess. The number,configuration and location of the grooves 77 correspond to the number,configuration and location of grooves 50. Accordingly, in the case ofnose 60, six grooves 77 are provided in nose 60 at 60° spaced locationsabout the central longitudinal axis of nose 60, and the grooves 77 aredefined by concave interior surfaces of nose 60 corresponding to concavesurfaces 51. When the front drive shaft 12 is assembled to the body 58and the nose 60 as shown in FIG. 2, the proximal intermediate section 24of the front drive shaft 12 extends entirely through the nose 60, theproximal intermediate section 24 extending through the bore 75 and theshallow recess disposed at the open distal end of the nose 60. As shownin FIG. 4, the grooves 77 of nose 60 are in alignment with the grooves50 of the front drive shaft 12. Accordingly, each groove 50 is alignedin a radial direction, about the central longitudinal axis of driveshaft 12, with a groove 77 to form an aligned pair of grooves. Anannular insert or seal 78, preferably made of stainless steel, isdisposed in the shallow recess at the open distal end of nose 60 and hasan outer diameter corresponding to the diameter of the shallow recessand an inner diameter corresponding to the external diameter of proximalintermediate section 24 while allowing the drive shaft 12 to movelongitudinally therethrough.

[0061] As further shown in FIG. 4, a linear bearing including a cage 80,not shown in FIG. 2, and a plurality of spherical balls 81 is preferablydisposed in bore 75 between the front drive shaft 12 and the nose 60.Preferably, the cage 80 includes a tubular or hollow cylindrical memberhaving a plurality of circular holes therein for receiving or retainingballs 81, the cage 80 having an outer diameter to be received in thediameter of bore 75 and an inner diameter to receive the externaldiameter of proximal intermediate section 24. The cage 80 is, as anexample, secured to the proximal intermediate section 24 of front driveshaft 12, such as being shrink fit thereon, and has a lengthcorresponding to the length of grooves 50. A first set of six holes isprovided in cage 80 and a second set of six holes is provided in cage 80longitudinally spaced from the first set of six holes. The holes of eachset are disposed at 60° spaced, radial locations about the centrallongitudinal axis of drive shaft 12 such that each hole is aligned withan aligned pair of grooves 50 and 77, as shown in FIG. 4, when the frontdrive shaft 12 is assembled to the housing 57. Each hole of cage 80 hasa diameter corresponding to the diameter of the balls 81, and each ball81 is disposed in a hole of cage 80 to protrude into the grooves 50 and77 aligned therewith, each ball 81 being captured between the concavesurfaces of the aligned grooves, respectively. Each ball 81 is thuslypartly disposed in the groove 50 and partly disposed in the groove 77 ofan aligned pair of grooves. The balls 81 are capable of freely rotatingwithin the holes of cage 80, respectively, and the aligned grooves 50and 77 of the nose 60 and the front drive shaft 12. In addition, as thedrive shaft 12 is reciprocated relative to and within the housing 57,each ball 81 moves longitudinally within at least one of the grooves ofthe associated aligned pair of grooves, or at least one of the groovesof each aligned pair of grooves moves longitudinally relative to theassociated ball 81. Where the cage 80 is attached or secured to thefront drive shaft 12, for instance, the cage 80 will move with the frontdrive shaft, and the balls 81 will move longitudinally within thegrooves 77 of nose 60. The cage 80 prevents displacement of the balls 81and thusly maintains the longitudinal spacing and position thereof. Itshould be appreciated that the cage 80 does not have to be secured tothe front drive shaft 12 and that the cage 80 can be secured to the nose60, in which case the grooves 50 move longitudinally relatively to theballs 81, or can merely be interposed between the nose 60 and the frontdrive shaft 12 without any mechanical connection between the cage andthe front drive shaft or the nose.

[0062] The motion converting mechanism 18 includes a cam 82, which issolid and preferably made of 17-4 PH stainless steel having a hardnessof H900, coupled with the rear drive shaft 14 and a cam follower 83,which is also preferably made of 17-4 PH stainless steel having ahardness of H900, coupled with the front drive shaft 12. The cam 82includes a cam head 84 disposed in the recess 54 of proximal section 26of front drive shaft 12 and a cam shaft or rod 85 extending proximallyfrom cam head 84 and disposed within the bore 65 of proximal section 63of body 58. The cam shaft 85 extends through the open proximal end ofbody 58 and is connected to or formed as part of the rear drive shaft14, which extends externally of the body 58. An annular insert or sealis disposed in the open proximal end of body 58 with the cam shaft 85extending proximally through the insert or seal. As shown in FIGS. 2 and6, the cam head 84 includes forward and rearward cam head sections 86and 86′, respectively, between which is defined a groove or track 87.The forward and rearward cam head sections 86 and 86′ each have a planarend surface, perpendicular to a central longitudinal axis of cam 82, anda non-planar cam surface, non-perpendicular or disposed at an angle tothe central longitudinal axis of cam 82. The planar end surface offorward cam head section 86 defines a distal end of cam head 84 whilethe planar end surface of rearward cam head section 86′ is disposed at aproximal end of cam head 84 such that the track 87 is defined betweenthe cam surfaces.

[0063] The forward and rearward cam head sections 86 and 86′ each have amaximum length tapering to a minimum length between their planar endsurfaces and their non-planar cam surfaces, respectively, the minimumlength being located 180° from the maximum length about the centrallongitudinal axis of cam 82. The forward and rearward cam head sections86 and 86′ are arranged such that the maximum length of forward cam headsection 86 is longitudinally aligned with the minimum length of therearward cam head section 86′, and the minimum length of the forward camhead section 86 is longitudinally aligned with the maximum length of therearward cam head section 86′. Accordingly, the maximum length of theforward cam head section 86 and the minimum length of the rearward camhead section 86′ are disposed at the same radial location about thecentral longitudinal axis of cam 82, while the minimum length of theforward cam head section 86 and maximum length of the rearward cam headsection 86′ are disposed at a radial location located 180° from theradial location of the maximum length of the forward cam head section 86and the minimum length of the rearward cam head section 86′. The forwardand rearward cam head sections 86 and 86′, respectively, each have amaximum external transverse or diametric dimension, which defines amaximum, external transverse or diametric dimension for the cam head 84.An intermediate cam head section of the cam head 84, around which thepath of track 87 is defined, extends between the forward and rearwardcam head sections and has a cylindrical configuration with an externaldiameter that is less than or smaller than the maximum externaltransverse or diametric dimension of the forward and rearward cam headsections. The cam head 84 has a length, between the planar end surfacesthereof, less than the length of recess 54 of proximal section 26 offront drive shaft 12 as shown in FIG. 2. The maximum, externaltransverse or diametric dimension of cam head 84 corresponds or is closein size to the diameter of recess 54 while allowing the cam head 84 torotate, relative to the front drive shaft 12, within recess 54 andallowing the front drive shaft 12 to reciprocate or move longitudinally,relative to the cam 82, within the recess 64 of body 58. The cam shaft85 is rotatable in the bore 65 of proximal section 63 of body 58, andthe cam head 84 is rotated with the cam shaft 85 such that the cam 82rotates relative to the housing 57. The cam 82 is secured in the housing57 against longitudinal movement relative to the housing 57.

[0064] The cam follower 83 includes an externally threaded end securedin aperture 56 of proximal section 26 via engagement of an externalthread of the cam follower 83 with the internal thread of aperture 56.The cam follower 83 includes a projection or protrusion 88longitudinally aligned with the externally threaded end thereof andextending from the externally threaded end thereof into the recess 54 ofthe proximal section 26. The projection 88 is disposed in the track 87of cam 82, which is coaxially aligned with the front drive shaft 12. Inthis manner, the proximal end of the front drive shaft 12 ismechanically coupled to or in driving engagement with the rear driveshaft 14 via the motion converting mechanism. The projection 88 has alength, in a direction parallel to the central longitudinal axis ofadapter 10, to be received between the cam surfaces of the cam head 84and has a height to be received in the space defined by track 87 betweenthe maximum external transverse or diametric dimension of the forwardand rearward cam head sections and the external diameter of theintermediate cam head section. When the maximum length of forward camhead section 86 and the minimum length of rearward cam head section 86′are longitudinally aligned with the projection 88 as shown in FIG. 2,the front drive shaft 12 is in a proximalmost longitudinal position,with the distal end of the front drive shaft 12 disposed a minimumlongitudinal distance beyond the housing 57. When the cam 82 is rotatedfrom the position shown in FIG. 2, the projection 88 follows the path oftrack 87 causing the front drive shaft 12 to be moved longitudinally,distally relative to the cam 82 and, therefore, relative to the reardrive shaft 14 and the housing 57. Once the cam 82 has been rotated 180°from the position shown in FIG. 2, such that the minimum length of theforward cam head section 86 and the maximum length of the rearward camhead section 86′ are longitudinally aligned with the projection 88, thefront drive shaft 12 will be in a distalmost longitudinal position withthe distal end thereof disposed a maximum longitudinal distance beyondhousing 57. Further rotation of the cam 82 in the same rotationaldirection causes the front drive shaft 12 to move longitudinally,proximally from the distal most longitudinal position; and, when the cam82 has been rotated an additional 180°, the front drive shaft 12 willhave been returned to the proximalmost longitudinal position. When therear drive shaft 14 is continuously turned or rotated by the motor ofhandpiece 16, the front drive shaft 12 is continuously reciprocated ormoved longitudinally back and forth, distally and proximally. As thefront drive shaft 12 is reciprocated, the proximal section 26 thereofmoves longitudinally within the recess 64 of body 58.

[0065] The rear drive shaft 14 for adapter 10 is preferably made of 17-4PH stainless steel having a hardness of H900 and has a distal endsecured to a proximal end of cam shaft 85, the rear drive shaft 14 beingin axial alignment with cam 82. The rear drive shaft 14 has a proximalend for being removably coupled with the handpiece 16. The rear driveshaft 14 can be formed as a separate member secured to cam shaft 85 orthe rear drive shaft can be formed integrally, unitarily with the camshaft; and, accordingly, the rear drive shaft 14 cannot movelongitudinally relative to the housing 57. The rear drive shaft 14 is atleast partly tubular with the proximal end thereof being open and incommunication with a lumen extending distally in the rear drive shaftfrom the open proximal end thereof. A plurality of oblong slots 90 areformed in the proximal end of rear drive shaft 14 at 90° spacedlocations about a central longitudinal axis of rear drive shaft 14,which is coaxial or coincident with the central longitudinal axis ofadapter 10. The slots 90 extend longitudinally, parallel to the centrallongitudinal axis of adapter 10, to define a plurality of spaced prongs91. Each slot 90 has a distal portion of uniform width and a proximalportion of increasing width in the proximal direction such that theproximal portions of the slots 90, respectively, flare out from thedistal portions thereof to provide prongs 91 with triangular shapedtips. The rear drive shaft 14 is thusly adapted to be operativelycoupled with the handpiece 16, which is the XPS™ StraightShot handpieceof Xomed, Inc. disclosed in the patent applications incorporated hereinby reference. In particular, drive pins of the front drive shaft of thehandpiece 16 are disposed in a pair of opposed slots 90 in drivingengagement with prongs 91 in the same manner as disclosed in the priorapplications incorporated herein by reference for coupling a blade orcutting member to the handpiece. In this manner, the proximal end of therear drive shaft has a configuration to mate with the drive shaft of thehandpiece.

[0066] The adapter 10 is coupled with the handpiece 16 by moving themiddle collet member of the handpiece longitudinally proximally,relative to the outer collet member of the handpiece, to the retractedposition, causing ball bearings within the middle collet member to bealigned with the forward passage segment of the middle collet member.The proximal end of rear drive shaft 14 is introduced in thelongitudinal passage of the middle collet member and is movedlongitudinally, proximally further into the handpiece to enter thelongitudinal passage of the inner collet member of the handpiece 16 suchthat the drive pins of the front drive shaft of the handpiece enter theslots 90, the triangular prongs 91 providing a self-centering functionfacilitating entry of the drive pins of the handpiece 16 into a pair ofopposed slots 90 of the rear drive shaft 14 of the adapter 10. Theannular flange 66 on body 58 enters the passage of the inner colletmember, causing the ball bearings of the middle collet member to bemoved outwardly from their holes. When the rear drive shaft 14 isinserted in the handpiece 16 in proper engagement with the front driveshaft of the handpiece, a proximal surface or face of flange 66 will bein abutment with an internal shoulder of the inner collet member of thehandpiece 16, and the partial spherical recesses 67 of flange 66 will bein alignment with the holes that receive the ball bearings of thehandpiece. When the middle collet member of handpiece 16 is thereafterreleased, it is returned to the extended position due to the bias of aspring, causing the ball bearings to be moved inwardly into the partialspherical recesses 67 of flange 66. Accordingly, flange 66 of adapter 10is prevented by the ball bearings from moving longitudinally androtationally relative to the handpiece 16, and the adapter 10 istherefore locked in place on the handpiece 16 as described in the priorapplications incorporated herein by reference. With the adapter 10thusly coupled with the handpiece 16, rotation of the drive shaft of thehandpiece 16 is effected by an electric motor of the handpiece 16,causing rotation of the rear drive shaft 14 therewith. Rotation of reardrive shaft 14 by handpiece 16 causes the front drive shaft 12 of theadapter 10 to be reciprocated via conversion or transformation of therotary motion of the rear drive shaft 14 into reciprocating motion ofthe front drive shaft 12 via the motion converting mechanism 18.Operation of handpiece 16 to rotate the drive shaft thereof is typicallycontrolled via a console or a foot switch as described in the priorapplications incorporated herein by reference.

[0067] The adapter 10 is preferably made of durable, medicallyacceptable materials, such as stainless steel or hard coated anodizedaluminum or titanium, for example, capable of being sterilized tomedical standards, such as by steam or flash autoclaving, gassterilization and/or soaking in a disinfectant solution. Accordingly,the adapter 10 is designed for repeated use. As described in the priorapplications incorporated herein by reference, the handpiece 16 is alsodesigned for repeated use. The adapter 10 can include various sizes offront and rear drive shafts and/or motion converting mechanisms inaccordance with the types of blades or cutting members to be driven bythe adapter, the stroke desired for the blades or cutting members and/orthe force or stress to which the blades or cutting members are to besubjected during use. The difference between the maximum and minimumlengths of the rearward cam head section 86′ defines the stroke for thefront drive shaft 12, i.e. the distance that the distal end of the frontdrive shaft 12 travels between the proximalmost and the distalmostlongitudinal positions. Accordingly, it should be appreciated that thestroke of the front drive shaft 12 and, therefore, the stroke of theblade or cutting member coupled therewith, can be varied or adjustedwith the use of different cam heads. In a preferred adapter according tothe present invention for use with a reciprocating rasp as describedbelow, the cam head is designed to provide a stroke of 3.0 mm. Inanother preferred adapter according to the present invention for usewith a reciprocating osteotome as described below, the cam head isdesigned to provide a stroke of 2.0 mm.

[0068] An alternative cam is illustrated at 182 in FIG. 7. The cam 182is similar to cam 82 except that the cam head 184 for cam 182 isconfigured so as to obtain a smaller stroke for the front drive shaft 12and, therefore, for a blade or cutting member coupled to the front driveshaft 12. Cam head 184 includes track 187 between forward and rearwardcam head sections 186 and 186′, respectively. The rearward cam headsection 186′ has a maximum length that is less than the maximum lengthof rearward cam head section 86′ and has a minimum length that isgreater than the minimum length of rearward cam head section 86′.Accordingly, the difference between the maximum and minimum lengths ofrearward cam head section 186′ is less than the difference between themaximum and minimum lengths of rearward cam head section 86′ such thatthe stroke provided by cam head 184 is smaller than that provided by camhead 84.

[0069] In the powered surgical handpiece assembly of FIG. 1, the adapter10 is coupled with the XPS™ StraightShot handpiece 16 and with anosteotome 294 described below. It should be appreciated, however, thatthe adapter 10 can be coupled with various handpieces and cuttingmembers to form a powered surgical handpiece assembly. The adapter 10coupled with the ostetome 294 forms a handpiece adapter assembly.However, a handpiece adapter assembly can be formed by adapter 10coupled with various cutting members.

[0070] A blade or cutting member 94 according to the present inventionfor being reciprocatively driven by a reciprocative driver isillustrated in FIGS. 8 and 9 and is a surgical rasp, preferably made ofstainless steel, including an elongate, cylindrical member or shaft 95,a tissue cutting element 96 disposed at a distal end of shaft 95 and asuction passage 97 communicating with the cutting element 96. Thecutting element 96 has a wedge shaped configuration with a planar lowersurface 98 and a gently curved or rounded upper surface 99 disposed atan angle to lower surface 98. The lower surface 98 has an oblongperimetrical configuration defined generally as a rectangle with curvedor rounded corners. The upper surface 99 is joined to or merges with theperimeter of lower surface 98. The cutting element 96 has a distal enddefined by a curved or arcuate edge portion of its perimeter and has aheight, between lower and upper surfaces 98 and 99, respectively, thatincreases in the proximal direction from the distal end thereof. Aproximal end of the cutting element 96 is joined or connected to thedistal end of shaft 95 with the lower surface 98 parallel to butlaterally offset from a central longitudinal axis of shaft 95. The lowersurface 98 is also laterally offset from an external diametric orcircumferential surface of shaft 95 such that the lower surface 98protrudes laterally beyond the shaft 95.

[0071] An oval shaped hole or aperture 92 is formed in lower surface 98in communication with a channel 93 that extends angularly, proximallyfrom the hole 92 through the cutting element 96, the hole 92 having acenter that is disposed in a plane containing the central longitudinalaxis of shaft 95. Preferably, the channel 93 is disposed at an angle of30° to the lower surface 98. A plurality of tissue cutting, removing orabrading ridges 100 are disposed on the entire remaining area of lowersurface 98 and are adapted to cut, remove, shape or abrade anatomicaltissue, such as bone, when the cutting element 96 is reciprocated alongthe tissue. The ridges 100 can have various configurations, such asbeing formed by triangular or diamond-shaped protuberances as shown, andcan be arranged in various patterns on lower surface 98. The ridges 100can be of various sizes or sharpness such that a series of rasps can beprovided having various degrees of coarseness or sharpness, such asfine, medium and coarse degrees of coarseness or sharpness. The suctionpassage 97 includes a suction tube 89, preferably made of stainlesssteel, secured within the channel 93 and having an open distal end 101terminating at the lower surface 98 and an open proximal end terminatingat a fitting 102 disposed proximally of cutting element 96. The opendistal end 101 of the suction passage 97 defines an inlet opening alongthe lower surface 98 through which anatomical debris, such as bloodand/or anatomical tissue, enters the lumen of the suction tube 89 to betransported away from the cutting element 96 and, therefore, away froman operative site at which the blade or cutting member 94 is used. Thefitting 102 defines an outlet opening of the suction passage 97 disposedproximally of the distal end of shaft 95.

[0072] It should be appreciated that the open distal end 101 of thesuction tube 89 can be disposed within the channel 93 without beingaligned or flush with or disposed in the same plane as lower surface 98,in which case the suction passage 97 will be formed by the suction tube89 and by a portion of the channel 93 with the hole 92 in lower surface98 constituting the inlet opening of the suction passage. The fitting102 is adapted to be connected to a first end of a length of flexible,plastic tubing having a second end coupled or connected with a source ofsuction, such as a suction pump or vacuum. The suction tube 89 extendsangularly and rearwardly from the upper surface 99 of the cuttingelement 96 and extends proximally alongside the shaft 95. A proximallength segment of the suction tube 89 is angled upwardly from the shaft95 and terminates at the fitting 102. Preferably, the suction tube 89 issecured to the shaft 95, such as by welding, soldering or variousadhesives. A central longitudinal axis of the suction passage 97 isdisposed in the same plane as the central longitudinal axis of shaft 95.The shaft 95, which preferably is solid, has a diameter for beingclosely received within the passage 46 of front drive shaft 12. Atransverse slot 103 is formed through the proximal end of shaft 95 anddefines a pair of spaced prongs 104 for being disposed on oppositesides, respectively, of the alignment member 48 of the adapter 10. Inthis manner, the proximal end of the cutting member is configured toengage the alignment member of the adapter when the cutting element isin a specific orientation relative to the adapter. The specificorientation for the cutting element relative to the adapter correspondsto the configuration of the proximal end of the rear drive shaft of theadapter in that the rear drive shaft of the adapter is configured todrivingly engage the drive shaft of the handpiece when the cuttingelement is in the specific orientation relative to the handpiece. Thespecific orientation for the cutting element is the desired orientationfor use of the cutting member via manual manipulation of the handpiecewhen grasped and held in the normal or intended manner for grasping andholding of the handpiece.

[0073] The cutting members used in the powered surgical handpieceassembly according to the present invention can have cutting elementsdesigned in various ways with various configurations in accordance withthe types of cutting functions to be performed therewith. For example,the cutting element can be designed to cut anatomical tissue, such asbone, by abrading the anatomical tissue as in the case of cuttingelement 96, by incising, resecting or otherwise removing, shaping and/orcontouring the tissue. Accordingly, as used herein, “cutting” isintended to include abrasion, incision, removal, shaping and/orcontouring of anatomical tissue as well as other tissue cuttingfunctions involving reciprocation of the cutting element.

[0074] The blade or cutting member 94 is coupled with the adapter 10 byinserting the proximal end of shaft 95 into the longitudinal passagesection 32 of distal section 20 of front drive shaft 12 with the nut 38in the distal longitudinal position so that the collet is open. Theproximal end of shaft 95 is moved through longitudinal passage section32 into and through the longitudinal passage section 36 of distalintermediate section 22 and into the longitudinal passage section 44 ofproximal intermediate section 24. The shaft 95 is rotated, as necessary,while being pushed proximally until the alignment member 48 enters theslot 103. The prongs 104 will then be disposed on opposite sides of thealignment member 48, which prevents rotation of the shaft 95 relative tothe front drive shaft 12. Engagement of the prongs 104 with thealignment member 48 can be confirmed tactilely, by being felt by thesurgeon, and audibly, by a clicking sound, as the alignment memberengages the prongs. The central longitudinal axis of shaft 95 will becoaxial with the central longitudinal axis of the adapter 10.

[0075] When the front drive shaft 12 is in the rotational positionillustrated in FIG. 2, the alignment member 48 is oriented vertically;and, when the vertically oriented alignment member is disposed in theslot 103, the blade or cutting member 94 will be positioned such thatthe lower surface 98 faces downwardly relative to the adapter 10 andrelative to the handpiece 16 when the adapter is coupled to thehandpiece 16 and the handpiece 16 is in the normal or intended positionfor being grasped or held by a surgeon. An indicating or reference markcan be provided on the adapter 10 indicative of the position of thealignment member 48. The adapter 10 can be thusly assembled to thehandpiece 16 and the blade or cutting member 94 can be assembled to theadapter 10 such that the cutting element is in the specific orientationfor use thereof. In the case of cutting member 94, the cutting element96 is oriented for use as a rasp with the cutting surface 98 facingdownwardly and disposed in a plane perpendicular to the plane containingthe central longitudinal axis of shaft 95, adapter 10 and the driveshaft of handpiece 16, respectively, as shown in FIG. 14.

[0076] A handpiece adapter assembly is formed by rasp 94 coupled withadapter 10. It should be appreciated however, that a handpiece adapterassembly can be formed by rasp 94 coupled to various adapters capable ofreciprocating the rasp 94 in response to the adapters being rotatablydriven. A powered surgical handpiece assembly is formed by rasp 94coupled with the XPS™ StraightShot handpiece 16 via the adapter 10.However, a powered surgical handpiece assembly can be formed by rasp 94coupled with various rotary handpieces via various adapters capable ofreciprocating the rasp 94 in response to the adapters being rotatablydriven by the handpieces.

[0077] An alternative blade or cutting member according to the presentinvention, which is also a rasp, is illustrated at 194 in FIG. 10. Thecutting member 194 is similar to the cutting member 94 except that theshaft 195 of cutting member 194 has a longitudinally straight proximallength segment and a longitudinally curving distal length segment. Thecutting element 196 of cutting member 194 is similar to cutting element96 and has a proximal end joined to a distal end of shaft 195. Thesuction passage 197 for cutting member 194 is similar to the suctionpassage 97, except that the suction tube 189 of suction passage 197follows the curvature of the distal length segment of shaft 195 andextends further proximally of the distal end of shaft 195 than thesuction tube 89. The cutting member 194 is particularly advantageous foruse in supraorbital facial procedures, and the curvature of shaft 195corresponds to or mimics the natural curvature of the human head and, inparticular, the forehead, between the upper hairline and the eyebrow. Aswith cutting member 94, the cutting member 194 has prongs (not visiblein FIG. 10) to insure proper alignment of the cutting member 194relative to the adapter 10 and the handpiece 16. When the prongs ofcutting member 194 are disposed on opposite sides of the alignmentmember 48, the proximal length segment of shaft 195 will be coaxial withthe central longitudinal axis of front drive shaft 12. The cuttingsurface 198 of cutting element 196 will face downwardly relative to theadapter 10, and relative to the handpiece 16 when the adapter 10 iscoupled thereto, and the cutting surface 198 will be disposed at anacute angle to the central longitudinal axis of adapter 10 as shown inFIG. 17.

[0078] As with the rasp 94, the rasp 194 forms a handpiece adapterassembly when the rasp 194 is coupled to adapter 10. However, ahandpiece adapter assembly can be formed by rasp 194 coupled withvarious adapters capable of reciprocating the rasp 194 in response tothe adapters being rotatably driven. A powered surgical handpieceassembly is formed by rasp 194 coupled with the XPS™ StraightShothandpiece 16 via the adapter 10. It should be appreciated, however, thata powered surgical handpiece assembly can be formed by rasp 194 coupledwith various rotary handpieces via various adapters capable ofreciprocating the rasp 194 in response to the adapters being rotatablydriven by the handpieces.

[0079] A blade or cutting member, which is an osteotome, to bereciprocatively driven by the handpiece 16 via the adapter 10 isillustrated at 294 in FIGS. 1,11 and 12. The cutting member 294 includesan elongate cylindrical member or shaft 295, the proximal end of whichis provided with a slot 303 forming prongs 304, and the distal end ofwhich is joined to or formed as a cutting element 296. The cuttingelement 296 has a longitudinally straight proximal length portion joinedto the distal end of shaft 295 and including flat or planar lateralsurfaces 305 a and 305 b connected by curved upper and lower surfaces306 a and 306 b, respectively. The lateral surfaces 305 a and 305 b areangled inwardly toward one another from the distal end of shaft 295 suchthat the proximal length portion of cutting element 296 is of graduallydecreasing width, defined between lateral surfaces 305 a and 305 b, inthe distal direction. The cutting element 296 has a longitudinallystraight distal length portion merging and continuous with the proximallength portion thereof. The distal length portion of cutting element 296has a curved upper surface 306 a′ and a substantially flat lower surface306 b′ merging and continuous with the upper and lower surfaces 306 aand 306 b, respectively. An upper part of the distal length portion ofcutting element 296 extends further distally than a lower part thereofand has flat or planar lateral surfaces 305 a′ and 305 b′, respectively,merging and continuous with lateral surfaces 305 a and 305 b,respectively.

[0080] The lower part of the distal length portion of cutting element296 has lateral surfaces 305 a″ and 305 b″ merging and continuous withthe lateral surfaces 305 a and 305 b, respectively. The lateral surfaces305 a′ and 305 b′ are angled inwardly toward one another from thelateral surfaces 305 a and 305 b, respectively, such that the upper partof the distal length portion is of gradually decreasing width, definedbetween the lateral surfaces 305 a′ and 305 b′, in the distal direction.In the case of the osteotome 294, the lateral surfaces 305 a′ and 305 b′are angled inwardly toward one another at a greater or steeper anglethan surfaces 305 a and 305 b. It should be appreciated, however, thatthe lateral surfaces 305 a′ and 305 b′ can follow or continue the angleor taper of the lateral surfaces 305 a and 305 b, respectively. Thelateral surfaces 305 a″ and 305 b″ are also angled inwardly toward oneanother from the lateral surfaces 305 a and 305 b, respectively, thelateral surfaces 305 a″ and 305 b″ being angled inwardly toward oneanother at a greater or steeper angle than surfaces 305 a′ and 305 b′.The lower part of the distal length portion is therefore of graduallydecreasing width, defined between lateral surfaces 305 a″ and 305 b″, inthe distal direction, and the width of the lower part decreases agreater amount or rate in the distal direction than the width of theupper part. Accordingly, the lateral surfaces 305 a″ and 305 b″ arerecessed with respect to the lateral surfaces 305 a′ and 305 b″,respectively, such that the lateral surfaces 305 a″ and 305 b″ aredisposed laterally inwardly of the lateral surfaces 305 a′ and 305 b′,respectively, with the lateral surfaces 305 a′ and 305 b′ disposedlaterally outwardly of the lateral surfaces 305 a″ and 305 b″,respectively.

[0081] The lateral surface 305 a′ is connected to the lateral surface305 a″ by a transverse surface 307 a, and the lateral surface 305 b′ isconnected to the lateral surface 305 b″ by a transverse surface 307 b.The lateral surfaces 305 a″ and 305 b″, merge or connect distally withone another at a transverse distal edge 308, which is transverse to thetransverse surfaces 307 a and 307 b. The edge 308 is in line with but istransverse to the central longitudinal axis of shaft 295, which definesthe central longitudinal axis of the cutting member 294. The lateralsurfaces 305 a′ and 305 b′ of the upper part of the distal lengthportion of the cutting element 296 terminate or merge distally at arounded or blunt tip 309 disposed distally of edge 308. The distal edge308 is sharp and forms a cutting edge capable of cutting anatomicaltissue, such as bone, when the cutting member 294 is advanced by thesurgeon into and/or along the tissue while being reciprocated by theadapter. The blunt tip 309 leads the cutting element 296 as the cuttingmember 294 is advanced into and/or along the anatomical tissue, the tip309 and the upper part of the distal length portion serving to guide thecutting element 296 and to separate, protect or guard adjacent orsurrounding anatomical tissue from the cutting edge 308. The cuttingmember 294 is particularly advantageous for use in forming a straightmedial cut in the nasal bone of a patient in a rhinoplasty procedure asdescribed further below.

[0082] As with the rasps 94 and 194, the osteotome 294 forms a handpieceadapter assembly when the osteotome 294 is coupled to adapter 10.However, a handpiece adapter assembly can be formed by osteotome 294coupled with various adapters capable of reciprocating the osteotome 294in response to the adapter being rotatably driven. A powered surgicalhandpiece assembly is formed by osteotome 294 coupled with the XPS™StraightShot handpiece 16 via the adapter 10. It should be appreciated,however, that a powered surgical handpiece assembly can be formed byosteotome 294 coupled with various rotary powered surgical handpiecesvia various adapters capable of reciprocating the osteotome 294 inresponse to the adapters being rotatably driven by the handpieces.

[0083] As noted above, various adapters can be used in the handpieceadapter assemblies and the powered surgical handpiece assembliesincluding adapters using an off-axis cam as the motion convertingmechanism. For example, the rear drive shaft of the adapter may be usedto rotate an off-axis roller of the adapter in an orbital manner causinga rocker engaged with the roller to exert a linear force on the frontdrive shaft via a link coupled to the rocker and the front drive shaft.

[0084] Another blade or cutting member, which is also an osteotome, tobe reciprocatively driven by the handpiece 16 via the adapter 10 isillustrated at 394 in FIG. 13. The cutting member 394 is similar to thecutting member 294 except that the distal length portion of the cuttingelement 396 of cutting member 394 is longitudinally curved or bent in alateral direction. Accordingly, the lateral surfaces 405 a′, 405 b′, 405a″ and 405 b″ of cutting element 396 are not flat or planar but, rather,are curved in the lateral direction. In this manner, the cutting edge408 and the blunt tip 409 are both laterally offset from and not in linewith the central longitudinal axis of shaft 395. The cutting member 394is particularly advantageous for use in forming a curved lateral cut inthe nasal bone of a patient in a rhinoplasty procedure as explainedfurther below.

[0085] As with the rasps 94 and 194 and the osteotome 294, the osteotome394 forms a handpiece adapter assembly when the osteotome 394 is coupledto adapter 10. However, a handpiece adapter assembly can be formed byosteotome 394 coupled with various adapters capable of reciprocating theosteotome 394 in response to the adapters being rotatably driven. Apowered surgical handpiece assembly is formed by osteotome 394 coupledwith the XPS™ StraightShot handpiece 16 via the adapter 10. It should beappreciated, however, that a powered surgical handpiece assembly can beformed by osteotome 3934 coupled with various rotary powered surgicalhandpieces via various adapters capable of reciprocating the osteotome394 in response to the adapters being rotatably driven by thehandpieces.

[0086] For use in a surgical procedure, such as a facial procedure, theadapter 10 is coupled with the handpiece 16 and a blade or cuttingmember selected in accordance with the surgical procedure to beperformed is coupled with the adapter 10 as described above. FIG. 14illustrates the rasp 94 coupled with the adapter 10, which is coupledwith the XPS™ StraightShot handpiece 16, forming a powered surgicalhandpiece assembly for use in a rhinoplasty procedure. In addition, alength of tubing Tomita et al is connected to the fitting 102 and to asource of suction (not shown). In the rhinoplasty procedure illustratedin FIG. 14, the cutting element 96 of the rasp 94 is introduced betweenthe nasal bone of the patient and the anatomical tissue A overlying thenasal bone. The cutting element 96 is introduced via an incision I madein the nasal passage P of the patient's nose as shown in FIG. 14 or viaan incision or flap made at or near the tip of the patient's nose. Theincision I is preferably no larger than necessary to receive the cuttingelement 96 to minimize trauma to the patient. The cutting element 96 isintroduced at an operative site between the nasal bone and the overlyingtissue A with the cutting element in the specific orientation so thatthe cutting surface 98 is disposed over and faces an area of the nasalbone that is to be reshaped or contoured via abrasion by the cuttingsurface 98. The cutting element 96 is positioned at the proper locationover the nasal bone via manipulation of handpiece 16 by the surgeon. Theskin of the patient overlying the location on the nasal bone that is tobe reshaped or contoured can be marked, such as with a medicallyacceptable ink, to facilitate proper positioning of the cutting element96. Proper positioning of the cutting element 96 can be confirmed viapalpation of the patient's nose by the surgeon since the cutting elementcan be felt beneath the overlying anatomical tissue A and can be seen asa bulge in the tissue A.

[0087] Once the cutting element 96 is properly located at the locationon the nasal bone that is to be shaped or contoured, the handpiece 16 isactuated, typically via an appropriate switch or foot pedal as describedin the prior applications incorporated herein by reference, to rotate orturn the motor of the handpiece 16. As the motor of handpiece 16 isturned or rotated, rotary motion of the drive shaft of the handpiece 16is converted to reciprocating motion of the front drive shaft 12 ofadapter 10 via the motion converting mechanism 18. For the rasp 94, themotor will typically be operated at a speed of 5,000 RPM. The rasp 94 isreciprocated with the front drive shaft 12; and, when the cuttingsurface 98 is placed in contact with the nasal bone, the ridges 100 ofthe cutting element 96 abrade and remove some of the nasal bone suchthat the nasal bone is reshaped or contoured. As the cutting element 96is reciprocated by the handpiece 16, the handpiece assembly is alsomoved longitudinally and/or laterally by the surgeon with the cuttingsurface 98 in contact with the nasal bone, allowing the surgeon toreshape or contour the nasal bone in accordance with a desired result.

[0088] As the cutting element 96 is reciprocated, suction from thesuction source is applied at the operative site via the suction passage97. In this manner, anatomical debris, including blood and/or tissue,enters or is drawn into the inlet opening of the suction passage and isremoved from the operative site via the suction passage and the tubingTomita et al for withdrawal from the patient's body. Once sufficientbone has been removed with the cutting element 96 so that the nasal boneis shaped or contoured as desired, the rasp 94 is withdrawn from thepatient's nose via incision 1. Proper shaping Pr contouring of the nasalbone and removal of a desired amount of bone can be confirmed by thesurgeon via palpation of the patient's nose. In addition, it should beappreciated that the procedure can be performed as a minimally invasiveprocedure wherein a remote viewing device, such as an endoscope, is usedto provide visualization of the operative site. As an example, an imagereceiving end of an endoscope can be introduced at the operative sitethrough the same or a different incision in the patient's nose.

[0089]FIGS. 15 and 16 illustrate use of the osteotomes 294 and 394 inconjunction with adapter 10 and handpiece 16 to make medial and lateralcuts in the nasal bone of a patient in a rhinoplasty procedure. As aninitial step in the procedure, the skin of the patient's nose is markedwith markings M and L at locations overlying selected sites on the nasalbone at which medial and lateral cuts, respectively, are to be made inthe nasal bone, the markings M and L being generally indicative of theconfigurations or paths and the lengths for the medial and lateral cuts,respectively. FIG. 15 illustrates the osteotome 294 coupled with theadapter 10, which is coupled with handpiece 16, to form a poweredsurgical handpiece assembly. The cutting element 296 is introducedbetween the nasal bone of the patient and the anatomical tissue Aoverlying the nasal bone. The cutting element 296 is introduced throughan incision I made in the nasal passage P as shown in FIG. 15 or via anincision or flap made at or near the tip of the patient's nose. Theincision I is preferably no larger than necessary to receive the cuttingelement 296 to minimize trauma to the patient. The cutting element 296is introduced at an operative site between the nasal bone and theoverlying tissue A with the cutting element 296 in the specificorientation so that the lower surface 306 b′ is disposed upon the nasalbone with the cutting edge 308 at a site corresponding to a lower orbeginning end of the medial cut. The blunt tip 309 leads and guides thecutting edge 308 to the site on the nasal bone and separates andprotects surrounding anatomical tissue from injury by the cutting edge308 as the cutting edge 308 is advanced to the site via manipulation ofhandpiece 16 by the surgeon. Proper positioning of the cutting element296 can be confirmed via palpation of the patient's nose since thecutting element 296 can be felt beneath the overlying anatomical tissueA and since the cutting element forms a visible bulge in the overlyingtissue.

[0090] Once the cutting edge 308 is properly disposed at the site on thenasal bone at which the medial cut is to begin, the handpiece 16 isactuated causing reciprocation of cutting member 294 via the adapter 10.For the osteotome 294, the motor of the handpiece will typically beoperated at a speed of 6,000 RPM. As the cutting member 294 isreciprocated, the cutting edge 308 is moved into and along the nasalbone via manual manipulation of the handpiece assembly formed by adapter10, handpiece 16 and cutting member 294. In particular, the handpieceassembly is advanced longitudinally distally or forwardly by the surgeonwhile the cutting edge 308 is moved into the nasal bone. The handpiece16 may be angled upwardly relative to the nasal bone, as it is beingdistally advanced, to facilitate movement of the cutting edge 308 intothe bone. As indicated by the marking M, the medial cut has a straightconfiguration or path, and the cutting element 296 is advanced distallyor forwardly along this straight configuration or path to an upper orterminal end for the medial cut. The cutting edge 308 in contact withthe nasal bone as the cutting element 296 is moved forwardly therealongwhile being reciprocated at the same time, causes a straight medial cutof desired length to be formed in the nasal bone. The medial cut isformed very quickly with the reciprocating osteotome or cutting member294; and, once the medial cut is formed, the cutting member 294 iswithdrawn from the patient's nose via the incision I. Proper formationof the medial cut can be confirmed via palpation of the nose and/or aremote viewing device where the procedure is performed as a minimallyinvasive procedure.

[0091] Upon completion of the medial cut and withdrawal of the cuttingmember 294 from the patient's nose, the osteotome or cutting member 394is used to form a lateral cut in the nasal bone corresponding to markingL. The cutting member 294 is removed from the adapter 10, which remainscoupled with the handpiece 16, and the cutting member or osteotome 394is coupled with the adapter 10 to form another powered surgicalhandpiece assembly. The cutting element 396 of osteotome 394 isintroduced at the operative site through the incision I in nasal passageP. The cutting element 396 is introduced between the nasal bone and theoverlying anatomical tissue A with the cutting element 396 in thespecific orientation so that the lower surface 406 b′ is disposed uponthe nasal bone with the cutting edge 408 at a site corresponding to alower or beginning end of the lateral cut. The blunt tip 409 leads andguides the cutting edge 408 as the cutting edge 408 is advanced to thesite on the nasal bone and protects surrounding tissue from injury ordamage by the cutting edge 408. Proper positioning of the cuttingelement 396 can be confirmed by feel and by observing a bulge in theoverlying tissue A due to the presence of the cutting elementtherebeneath. As indicated by the marking L, the lateral cut is spacedlaterally from the medial cut and has a curved configuration or path.Accordingly, the osteotome or cutting member 394 that is being used bythe surgeon to make the lateral cut has its distal portion curvinglaterally in the same direction as the lateral cut as illustrated inFIG. 16.

[0092] Once the cutting edge 408 has been positioned at the proper siteon the nasal bone at which the lateral cut is to begin, the handpiece 16is actuated causing reciprocation of the cutting member 394 via theadapter 10. For the osteotome 394, the motor of the handpiece willtypically be operated at a speed of 6,000 RPM. As the cutting member 394is reciprocated, the cutting edge 408 is moved into and along the nasalbone via manipulation of the handpiece assembly. The powered surgicalhandpiece assembly formed by adapter 10, handpiece 16 and cutting member394 is advanced longitudinally distally or forwardly and is also movedangularly by the surgeon as the cutting edge 408 is moved into the nasalbone. As shown in dotted lines in FIG. 16, the handpiece assembly ismoved angularly or laterally in a pivoting motion so that the cuttingedge 408 follows the curved configuration or path for the lateral cutand cuts the nasal bone along a preferred angle. In this manner, acurved or angled lateral cut of a desired length is automatically madein the nasal bone as the surgeon merely guides the cutting element 408along the preferred curve or angle from the lower or beginning end to anupper or terminal end for the lateral cut. Once the lateral cut has beencompleted, the osteotome or cutting member 394 is removed from thepatient's nose via the incision I. Proper formation of the lateral cutcan be confirmed via palpation and/or a remote viewing device where theprocedure is performed as a minimally invasive procedure. Once themedial and lateral cuts have been completed, a rasp such as thereciprocating rasp 94, can be introduced at the operative site forshaping or contouring of the nasal bone as described above.

[0093] A supraorbital surgical procedure utilizing the rasp or cuttingmember 194 is illustrated in FIG. 17. The cutting member 194 is coupledwith the adapter 10, which is coupled with the handpiece 16, to form apowered surgical handpiece assembly as described above. In addition, alength of tubing Tomita et al is connected to the fitting 202 and to asource of suction. The cutting element 196 of cutting member 194 isintroduced between the frontal bone or forehead of the patient's headand overlying anatomical tissue A, the cutting element 196 beingintroduced through an entry point or incision I disposed at or behindthe patient's hairline. Preferably, the incision I is no larger thannecessary to receive the cutting element 196 to reduce trauma. Thecutting element 196 is moved, via manipulation of the handpiece assemblyby the surgeon, distally or forwardly along the patient's frontal boneuntil the cutting element 196 is positioned at an operative site at thesupraorbital bone just behind the patient's eyebrow. Passage of thecutting element 196 from the entry point or incision I to the operativesite at the supraorbital bone is facilitated due to the curvature of theshaft 195. The cutting element 196 is introduced between thesupraorbital bone and the overlying anatomical tissue A with the cuttingelement 196 in the specific orientation so that the cutting surface 198is disposed over and faces an area of the supraorbital bone that is tobe reshaped or contoured. Of course, the skin overlying the area of thesupraorbital bone that is to be reshaped or contoured can be marked asdescribed above. Proper positioning of the cutting element 196 can beconfirmed via palpation since the cutting element 196 can be feltbeneath the overlying tissue A as well as by the bulge created in theoverlying tissue A due to presence of the cutting element therebeneath.

[0094] Once the cutting element 196 is properly located at the locationon the supraorbital bone that is to be shaped or contoured, thehandpiece 16 is actuated causing reciprocation of cutting element 196.For the rasp 194, the motor of the handpiece will typically be operatedat a speed of 5,000 RPM. As the cutting element 196 is reciprocated bythe handpiece 16, the handpiece assembly is moved longitudinally and/orlaterally by the surgeon in order to correspondingly move the cuttingelement 196 and thusly abrade and remove some of the supraorbital boneas described above for rasp 94. As the cutting element 196 isreciprocated, suction from the suction source is applied at theoperative site via the suction passage 197. In this manner, thesupraorbital bone is shaped or contoured in accordance with a desiredresult while anatomical debris enters the inlet opening of the suctionpassage 197 and is removed from the operative site via the suctionpassage 197 and the tubing Tomita et al for withdrawal from thepatient's body. The supraorbital bone can be felt through the overlyingtissue A when palpated by the surgeon to confirm proper shaping orcontouring of the supraorbital bone. Where the supraorbital procedure isperformed as a minimally invasive procedure, a remote viewing device canbe used to confirm proper shaping or contouring and removal of theproper amount of bone. Once the supraorbital bone has been properlyshaped or contoured and the proper amount of bone has been removedtherefrom, the rasp 194 is removed from the operative site and iswithdrawn through the incision I.

[0095]FIG. 18 illustrates an alternative and preferred arrangement forthe distal section of the front drive shaft and the nut of the surgicalhandpiece adapter. FIG. 18 illustrates a front drive shaft 512 havingdistal section 520 extending distally from distal intermediate section522. The distal intermediate section 522 is similar to distalintermediate section 22 and has an external thread 535 in threadedengagement with internal thread 541 of nut 538. The distal section 520includes a cylindrical rearward portion 528, a cylindrical intermediateportion 529 and a cylindrical forward portion 531 extending distallyfrom intermediate portion 529. The rearward portion 528 has an aperturetherein communicating with the passage 546 of the front drive shaft andreceiving a locking member in the form of a ball 513. The ball 513 has adiametric size capable of permitting protrusion of the ball 513 into thepassage 546 while preventing passage of the ball 513 entirely throughthe aperture. An insert or positioner 515, which is also a ball, isdisposed in a notch or recess of the rearward portion 528 and protrudesexternally of the front drive shaft 512 to engage an interior surface ofnut 538. The insert 515 assists in preventing longitudinal movement ofball 513 and maintaining alignment of ball 513 with its aperture.

[0096] The nut 538 is movable longitudinally relative to and along thefront drive shaft 512 in response to rotation of the nut 538 aspermitted by engagement of threads 535 and 541. When the nut 538 is in aproximal longitudinal position relative to the front drive shaft 512 asshown in FIG. 18, the distal section 520 is in a closed position whereina cylindrical interior surface of nut 538 engages ball 513 and forcesball 513 in a radially inward direction to protrude through the apertureinto the passage 546. The passage 546 is thusly closed so as to preventpassage of a proximal end of a blade or cutting member therethrough. Thecylindrical interior surface of nut 538 in engagement with ball 513 inthe closed position prevents the ball 513 from moving in a radiallyoutwardly direction. When the nut 538 is moved longitudinally distallyrelative to the front drive shaft 512 a sufficient distance, thecylindrical interior surface of nut 538 is disengaged from or moveddistally of the ball 513 such that the ball 513 is capable of moving inthe radially outward direction so that the ball 513 no longer protrudesinto the passage 546. The distal section 520 will then be in an openposition, with the ball 513 movable in the radially outward directiondue to the space or room presented between the front drive shaft and thenut when a sloping interior surface of the nut is aligned with the ball513. The passage 546 will then be in an open position allowing aproximal end of a blade or cutting member to pass therethrough. Theballs 513 and 515, being spherical, facilitate longitudinal movement ofthe nut 538 relative to the front drive shaft 512.

[0097] The arrangement depicted in FIG. 18 is adapted to be used with acutting member having an external annular groove thereon for beingengaged and disengaged with the ball 513 to selectively lock and unlockthe cutting member to the front drive shaft. FIG. 19 illustrates apreferred surgical rasp 694 adapted for use with an adapter having frontdrive shaft 512 and nut 538. Rasp 694 is the same as rasp 94 except thatshaft 695 for rasp 694 has an external annular or circumferential groove617 formed thereon. The groove 617 is disposed on shaft 695 at alocation aligned with ball 513 and its aperture when the shaft 695 isfully inserted in the passage 546 of the front drive shaft 512. Theshaft 695 is insertable in the passage 546 with the nut 538 in thedistal longitudinal position, the ball 513 being moved in the radiallyoutward direction by the shaft 695 to open the passage 546 as it isinserted therein. The ball 513 is thusly moved by the shaft 695 out ofthe passage 546 so that the distal section 520 is in the open positionallowing the shaft 695 to be fully inserted in the now open passage 546.Once the shaft 695 is fully inserted in passage 546, the nut 538 isrotated or turned to move it to the proximal longitudinal position. As aresult thereof, the ball 513 is moved in the radially inward directioncausing it to protrude through the aperture and into the groove 617aligned therewith. The distal section 520 will then be in the closedposition with the ball 513 received in the groove 617 and closing thepassage 546 to movement of the shaft 695 therethrough. Since the ball513 is captured it is prevented from moving longitudinally, and the rasp694 is locked to the front drive shaft 512. The rasp 694 is removable ordisengageable from the front drive shaft by moving the nut 538 to thedistal longitudinal position allowing the shaft 695 to be withdrawn frompassage 546. As the shaft 695 is withdrawn, it moves the ball 513 in theradially outward direction so that the distal section 520 is in the openposition.

[0098] Actuation of the powered surgical handpiece can be controlled sothat the motor thereof is turned or rotated at a desired speed inaccordance with the speed of reciprocation desired for the cuttingelement. The adapter according to the present invention permits therotary output of the powered surgical handpiece to be selectivelyconverted into reciprocating motion in order to reciprocatively drive ablade or cutting member. Although the adapter of the subject inventionis designed for use with the XPS™ StraightShot handpiece to allow theXPS™ StraightShot handpiece to be used to drive both rotary andreciprocative blades or cutting members, it should be appreciated thatthe adapter can be used with various powered surgical handpieces havingrotatable drive shafts. Accordingly, the proximal end of the rear driveshaft of the adapter can be designed in various ways allowing the reardrive shaft to be mechanically coupled to the drive shaft of thehandpiece. The adapter can be used to reciprocatively drive varioustypes of reciprocative blades or cutting members, and the adapter and ablade or cutting member coupled therewith forms a handpiece adapterassembly. The adapter can be used to drive reciprocative blades atvarious speeds to perform various cutting functions in anatomical tissueincluding bone. The adapter can be designed with a particular stroke anda plurality of adapters can be provided each having a different stroke.The adapter can be provided with an alignment member to ensure couplingof a blade or cutting member therewith in a specific orientation. Theadapter can be designed for mechanical coupling with the drive shaft ofthe handpiece with the blade or cutting member that is coupled with theadapter disposed in the specific orientation relative to the handpiece.In this manner, the blade or cutting member is in the proper orientationfor use thereof when the handpiece is grasped or held by the surgeon inthe normal manner. The adapter can be used in a powered surgicalhandpiece assembly to reciprocatively drive various blades or cuttingmembers thereof in surgical procedures that are performed minimallyinvasively. The adapter can be designed for reuse in conjunction with areusable handpiece and disposable blades or cutting members.

[0099] The rasps according to the present invention greatly facilitatethe performance of surgical procedures since anatomical debris isremoved from operative sites via the rasps themselves. The suctionpassages of the rasps have inlet openings disposed along cuttingsurfaces of the rasps and are thusly disposed at the source of theanatomical debris. The rasps can be provided with a longitudinal curveor bend particularly useful in specific procedures to access internaloperative sites from entry points or incisions disposed at locationsremote from the operative sites. The rasps can be provided with cuttingelements of varying sharpness or coarseness. A plurality or series ofrasps can be provided each having a different sharpness or coarseness.The rasps can be coupled with various adapters to form various handpieceadapter assemblies. The rasps can be coupled with various handpieces viavarious adapters to form various powered surgical handpiece assemblies.

[0100] The osteotomes greatly reduce the amount of time needed toperform various surgical procedures, particularly facial procedures suchas rhinoplasty. When used in a powered surgical handpiece assembly, theosteotomes allowed medial and lateral cuts to be formed in the nasalbone automatically, with the surgeon having only to guide the cuttingelements of the osteotomes. The osteotomes can be longitudinallystraight for formation of longitudinally straight cuts or longitudinallycurved or angled for formation of longitudinally curved or angled cuts.The blunt distal tips of the osteotomes lead and guide the cuttingelements of the osteotomes to operatives sties at which the osteotomesare to be used and protect surrounding anatomical tissue from unwantedcontact with the cutting edges. The osteotomes can be coupled withvarious adapters to form various handpiece adapter assemblies. Theosteotomes can be coupled with various handpieces via various adaptersto form various powered surgical handpiece assemblies.

[0101] The blades or cutting members can be provided with structurecooperable with structure of the adapter to ensure that the blades orcutting members are coupled to the adapter and, therefore, thehandpiece, in the proper orientation for use.

[0102] In as much as the present invention is subject to variousmodification, and changes in detail, it should be appreciated that thepreferred embodiments described herein should be considered asillustrative only and should not be taken in a limiting sense.

What is claimed is:
 1. A handpiece adapter for converting rotary motionof a powered surgical handpiece into reciprocating motion forreciprocatively driving a cutting member coupled to the handpieceadapter, said handpiece adapter comprising an adapter housing; a frontdrive shaft having a proximal end reciprocatively mounted in saidadapter housing and having a distal end disposed externally of saidadapter housing, said distal end being capable of being removablycoupled to a cutting member to be reciprocatively driven by said frontdrive shaft; a rear drive shaft having a distal end and having aproximal end capable of being removably coupled to a rotatable driveshaft of the powered surgical handpiece such that said rear drive shaftis rotated by the drive shaft of the powered surgical handpiece; a camdisposed at said distal end of said rear drive shaft and being rotatabletherewith, said cam being rotatably disposed in said adapter housing;and a cam follower disposed at said proximal end of said front driveshaft in engagement with said cam whereby rotation of said rear driveshaft by the drive shaft of the powered surgical handpiece is convertedinto reciprocation of said front drive shaft to reciprocatively drivethe cutting member coupled therewith.
 2. A handpiece adapter as recitedin claim 1 wherein said distal end of said front drive shaft includes apassage for receiving a proximal end of the cutting member.
 3. Ahandpiece adapter as recited in claim 2 and further including anoperating member carried on said front drive shaft for selectivelyopening said passage to receive the proximal end of the cutting memberand for selectively closing said passage to secure the proximal end ofthe cutting member to said front drive shaft.
 4. A handpiece adapter asrecited in claim 3 wherein said operating member is movablelongitudinally relative to and along said front drive shaft in a firstlongitudinal direction to selectively open said passage and is movablelongitudinally relative to and along said front drive shaft in a secondlongitudinal direction to selectively close said passage.
 5. A handpieceadapter as recited in claim 4 wherein said operating member includes alongitudinal passage extending entirely therethrough and said frontdrive shaft is disposed in said passage of said operating member to passentirely through said operating member, said operating member beingrotatable relative to said front drive shaft, said operating memberbeing movable longitudinally in said first longitudinal direction inresponse to rotation of said operating member in a first rotationaldirection relative to said front drive shaft, said operating memberbeing movable longitudinally in said second longitudinal direction inresponse to rotation of said operating member in a second rotationaldirection, opposite said first rotational direction, relative to saidfront drive shaft.
 6. A handpiece adapter as recited in claim 5 whereinsaid distal end of said front drive shaft is formed as a collet defininga plurality of longitudinally extending legs, said legs being movable ina radially outward direction to receive the proximal end of the cuttingmember in said passage of said front drive shaft when said operatingmember is moved in said first longitudinal direction, said legs beginmoved in a radially inward direction to engage the proximal end of thecutting member in said passage of said front drive shaft when saidoperating member is moved in said second longitudinal direction.
 7. Ahandpiece adapter as recited in claim 5 wherein a locking member isdisposed in an aperture formed in said front drive shaft andcommunicating with said passage of said front drive shaft, said lockingmember being movable in a radially outward direction to receive theproximal end of the cutting member in said passage of said front driveshaft when said operating member is moved in said first longitudinaldirection, said locking member being moved in a radially inwarddirection to protrude through said aperture into said passage of saidfront drive shaft so as to engage the proximal end of the cutting memberin said passage of said front drive shaft when said operating member ismoved in said second longitudinal direction.
 8. A handpiece adapter asrecited in claim 7 wherein said locking member is spherical.
 9. Ahandpiece adapter as recited in claim 7 and further including an insertdisposed in said passage of said operating member and maintainingalignment of said locking member with said aperture.
 10. A handpieceadapter as recited in claim 5 and further including a linear bearingdisposed around said front drive shaft.
 11. A handpiece adapter asrecited in claim 10 wherein said housing includes a housing portionhaving a longitudinal passage therethrough, said front drive shaftextends entirely through said passage of said housing portion, saidfront drive shaft has a central longitudinal axis and a plurality ofpartial spherical, longitudinally extending grooves in an externalsurface thereof, said grooves being disposed in said passage of saidhousing portion, said housing portion has a plurality of partialspherical, longitudinally extending grooves in an internal surfacethereof defining said passage of said housing portion, each of saidgrooves of said front drive shaft being aligned with one of said groovesof said housing portion in a radial direction about said centrallongitudinal axis of said front drive shaft to form an aligned pair ofgrooves, and said linear bearing includes a hollow cylindrical memberthrough which said front drive shaft passes and a plurality of ballsretained by said cylindrical member, said cylindrical member including aplurality of holes therein receiving said balls, respectively, each ofsaid holes being radially aligned with one of said aligned pair ofgrooves such that each of said balls is partly disposed in each of saidgrooves of said one of said aligned pair of grooves and islongitudinally movable within at least one of said grooves of said oneof said aligned pair of grooves as the front drive shaft is reciprocatedin said housing.
 12. A handpiece adapter as recited in claim 1 whereinsaid cam includes a cam head having an angled track therein and said camfollower is disposed in said track.
 13. A handpiece adapter as recitedin claim 12 wherein said proximal end of said front drive shaft has arecess therein and said cam head is rotatably disposed in said recess.14. A handpiece adapter as recited in claim 13 wherein said cam has acentral longitudinal axis and said cam head includes forward andrearward cam head sections between which said track is disposed, saidrearward cam head section having a maximum length and a minimum lengthdisposed at a 180° spaced location from said maximum length about saidcentral longitudinal axis of said cam, said cam follower includes aprotrusion on said front drive shaft disposed in said track, said distalend of said front drive shaft being in a maximum longitudinal positionbeyond said housing when said maximum length is in longitudinalalignment with said protrusion and being in a minimum longitudinalposition beyond said housing when said minimum length is in longitudinalalignment with said protrusion.
 15. A handpiece adapter as recited inclaim 14 wherein said cam head has an overall length and said recess hasa length greater than said overall length of said cam head allowing saidfront drive shaft to reciprocate relative to said rear drive shaft. 16.A handpiece adapter as recited in claim 15 wherein said proximal end ofsaid rear drive shaft is configured for mechanical coupling with thedrive shaft of the powered surgical handpiece.
 17. A handpiece adapteras recited in claim 16 wherein said proximal end of said rear driveshaft includes a slot for receiving a drive pin on the drive shaft ofthe powered surgical handpiece.
 18. A handpiece adapter as recited inclaim 1 wherein said handpiece adapter is reusable.
 19. A poweredsurgical handpiece assembly comprising a powered surgical handpiecehaving a rotatable drive shaft; a handpiece adapter including a re a rdrive shaft having a proximal end removably coupled with said driveshaft of said handpiece and having a distal end a front drive shafthaving a distal end and a proximal end, and a motion convertingmechanism mechanically coupling said proximal end of said front driveshaft with said distal end Of said rear drive shaft, said motionconverting mechanism including a cam at said distal end of said reardrive shaft and a cam follower at said proximal end of said front driveshaft, said rear drive shaft being rotatable with said drive shaft ofsaid handpiece, said cam being rotatable with said rear drive shaft,said cam follower being reciprocatively moved by said cam to reciprocatesaid front drive shaft in response to rotation of said cam by said reardrive shaft; and a cutting member having a proximal end removablycoupled with said distal end of said front drive shaft and having adistal end for cutting anatomical tissue, said cutting member beingreciprocatively driven by said front drive shaft of said adapter whensaid front drive shaft is reciprocated, via said motion convertingmechanism, in response to rotation of said drive shaft of saidhandpiece.
 20. A powered surgical handpiece assembly as recited in claim19 wherein said cutting member is a rasp.
 21. A powered surgicalhandpiece assembly as recited in claim 19 wherein said cutting member isan osteotome.
 22. A powered surgical handpiece assembly as recited inclaim 19 wherein said handpiece is an XPS™ StraightShot handpiece.
 23. Apowered surgical handpiece assembly as recited in claim 22 wherein saidcutting member is a rasp.
 24. A powered surgical handpiece assembly asrecited in claim 22 wherein said cutting member is an osteotome.
 25. Apowered surgical handpiece assembly as recited in claim 19 wherein saidhandpiece and said adapter are reusable and said cutting member isdisposable.
 26. A powered surgical handpiece assembly as recited inclaim 19 wherein said front drive shaft includes an alignment member andsaid proximal end of said cutting member is adapted to engage saidalignment member when said distal end of said cutting member is in aspecific orientation for use of said powered surgical handpieceassembly.
 27. A powered surgical handpiece assembly as recited in claim26 wherein said alignment member includes a post and said proximal endof said cutting member has a slot therein for receiving said post whensaid distal end of said cutting member is in said specific orientation.28. A powered surgical handpiece assembly as recited in claim 27 whereinsaid drive shaft of said handpiece includes a pin and said proximal endof said rear drive shaft includes a slot for receiving said pin whensaid distal end of said cutting member is in said specific orientation.29. A powered surgical handpiece assembly as recited in claim 27 whereinsaid proximal end of said rear drive shaft includes spaced prongs andsaid drive shaft of said handpiece includes a pin for being receivedbetween said prongs when said distal end of said cutting member is insaid specific orientation.
 30. A powered surgical handpiece assembly asrecited in claim 19 wherein said adapter includes a housing, saidproximal end of said front drive shaft is reciprocatively mounted insaid housing and said distal end of said front drive shaft is disposedexternally of said housing, said cam has a central longitudinal axis andincludes a cam head disposed in said housing, said cam has an angledtrack therein within which said cam follower is disposed, said cam headincludes forward and rearward cam head sections between which said trackis disposed, said rearward cam head section having a maximum length anda minimum length disposed at a 180° spaced location from said maximumlength about said central longitudinal axis of said cam, said camfollower includes a protrusion on said front drive shaft disposed insaid track, said distal end of said front drive shaft being in a maximumlongitudinal position beyond said housing when said maximum length is inlongitudinal alignment with said protrusion.
 31. A powered surgicalhandpiece assembly as recited in claim 30 wherein said proximal end ofsaid front drive shaft has a recess therein and said cam head isrotatably disposed in said recess, said cam head has an overall lengthand said recess has a length greater than said overall length of saidcam head allowing said front drive shaft to reciprocate relative to saidrear drive shaft.
 32. A powered surgical handpiece assembly as recitedin claim 19 wherein said distal end of said front drive shaft includes apassage receiving said proximal end of said cutting member, said adapterincludes an operating member carried on said front drive shaft forselectively opening said passage to receive said proximal end of saidcutting member and for selectively closing said passage to secure saidproximal end of said cutting member to said front drive shaft, saidoperating member includes a longitudinal passage extending entirelytherethrough and said front drive shaft is disposed in said passage ofsaid operating member to pass entirely therethrough, said operatingmember is rotatable relative to said front drive shaft, said operatingmember is movable longitudinally in a first longitudinal direction inresponse to rotation of said operating member in a first rotationaldirection relative to said front drive shaft, said operating member ismovable longitudinally in a second longitudinal direction in response torotation of said operating member in a second rotational direction,opposite said first rotational direction, relative to said front driveshaft.
 33. A powered surgical handpiece assembly as recited in claim 32wherein said distal end of said front drive shaft is formed as a colletdefining a plurality of longitudinally extending legs, said legs beingmovable in a radially outward direction to receive said proximal end ofsaid cutting member in said passage of said front drive shaft when saidoperating member is moved in said first longitudinal direction, saidlegs being moved in a radially inward direction to engage said proximalend of said cutting member in said passage of said front drive shaftwhen said operating member is moved in said second longitudinaldirection.
 34. A powered surgical handpiece assembly as recited in claim32 wherein a locking member is disposed in an aperture formed in saidfront drive shaft and communicating with said passage of said frontdrive shaft, said locking member being movable in a radially outwarddirection to receive said proximal end of said cutting member in saidpassage of said front drive shaft when said operating member is moved insaid first longitudinal direction, said locking member being moved in aradially inward direction to protrude through said aperture into saidpassage of said front drive shaft so as to engage said proximal end ofsaid cutting member in said passage of said front drive shaft when saidoperating member is moved in said second longitudinal direction.
 35. Apowered surgical handpiece assembly as recited in claim 34 wherein saidlocking member is configured as a ball.
 36. A powered surgical handpieceassembly as recited in claim 34 wherein said proximal end of saidcutting member has an external annular groove and said locking member isreceived in said groove when said operating member is moved in saidsecond longitudinal direction to lock said cutting member to said frontdrive shaft.
 37. A handpiece adapter assembly for a powered surgicalhandpiece comprising a handpiece adapter including a rear drive shafthaving a proximal end for being removably coupled with a rotatable driveshaft of a powered surgical handpiece and having a distal end, a frontdrive shaft having a distal end and a proximal end and a motionconverting mechanism by which said proximal end of said front driveshaft is in driving engagement with said distal end of said rear driveshaft, said rear drive shaft being rotatable with the drive shaft of thehandpiece when said rear drive shaft is coupled therewith, said motionconverting mechanism including a cam rotatable with said rear driveshaft and a cam follower reciprocatively moved by said cam in responseto rotation of said cam with said rear drive shaft, said front driveshaft being movable with said cam follower whereby said front driveshaft is reciprocated relative to said rear drive shaft when said reardrive shaft is rotated by the drive shaft of the handpiece; and acutting member having a proximal end removably coupled with said distalend of said front drive shaft and having a distal end for cuttinganatomical tissue, said cutting member being reciprocatively driven bysaid front drive shaft of said adapter when said front drive shaft isreciprocated in response to rotation of said rear drive shaft by thedrive shaft of the handpiece.
 38. A handpiece adapter assembly asrecited in claim 37 wherein said adapter includes an alignment memberand said proximal end of said cutting member is configured to drivinglyengage said alignment member when said distal end of said cutting memberis in a predetermined orientation relative to said adapter.
 39. Ahandpiece adapter assembly as recited in claim 38 wherein said frontdrive shaft includes a longitudinal passage receiving said proximal endof said cutting member, said alignment member includes a post extendingtransversely within said passage and said proximal end of said cuttingmember includes a slot receiving said post.
 40. A handpiece adapterassembly as recited in claim 38 wherein said front drive shaft includesa longitudinal passage receiving said proximal end of said cuttingmember, said alignment member includes a post extending transverselywithin said passage and said proximal end of said cutting memberincludes spaced prongs receiving said post therebetween.
 41. A handpieceadapter assembly as recited in claim 37 wherein said proximal end ofsaid rear drive shaft has a configuration to drivingly engage the driveshaft of the handpiece when said distal end of said cutting member is insaid predetermined orientation relative to the handpiece.
 42. Ahandpiece adapter assembly as recited in claim 37 wherein said cuttingmember is a rasp.
 43. A handpiece adapter assembly as recited in claim37 wherein said cutting member is an osteotome.
 44. A handpiece adapterassembly as recited in claim 37 wherein said adapter is reusable andsaid cutting member is disposable.
 45. A handpiece adapter assembly asrecited in claim 37 wherein said adapter includes a housing, saidproximal end of said front drive shaft is reciprocatively mounted insaid housing and said distal end of said front drive shaft is disposedexternally of said housing, said cam head has a central longitudinalaxis and includes a cam disposed in said housing, said cam has an angledtrack therein within which said cam follower is disposed, said cam headincludes forward and rearward cam head sections between which said trackis disposed, said rearward cam head section having a maximum length anda minimum length disposed at a 180° spaced location from said maximumlength about said central longitudinal axis of said cam, said camfollower includes a protrusion on said front drive shaft disposed insaid track, said distal end of said front drive shaft being in a maximumlongitudinal position beyond said housing when said maximum length is inlongitudinal alignment with said protrusion and being in a minimumlongitudinal position beyond said housing when said minimum length is inlongitudinal alignment with said protrusion.
 46. A handpiece adapterassembly as recited in claim 45 wherein said proximal end of said frontdrive shaft has a recess therein and said cam head is rotatably disposedin said recess, said cam head has an overall length and said recess hasa length greater than said overall length of said cam head allowing saidfront drive shaft to reciprocate relative to said rear drive shaft. 47.A handpiece adapter assembly as recited in claim 37 wherein said distalend of said front drive shaft includes a passage receiving said proximalend of said cutting member, said adapter includes an operating membercarried on said front drive shaft for selectively opening said passageto receive said proximal end of said cutting member and for selectivelyclosing said passage to secure said proximal end of said cutting memberto said front drive shaft, said operating member includes a longitudinalpassage extending entirely therethrough and said front drive shaft isdisposed in said passage of said operating member to pass entirelytherethrough, said operating member is rotatable relative to said frontdrive shaft, said operating member is movable longitudinally in a firstlongitudinal direction in response to rotation of said operating memberin a first rotational direction relative to said front drive shaft, saidoperating member is movable longitudinally in a second longitudinaldirection in response to rotation of said operating member in a secondrotational direction, opposite said first rotational direction, relativeto said front drive shaft.
 48. A handpiece adapter assembly as recitedin claim 47 wherein said distal end of said front drive shaft is formedas a collet defining a plurality of longitudinally extending legs, saidlegs being movable in a radially outward direction to receive saidproximal end of said cutting member in said passage of said front driveshaft when said operating member is moved in said first longitudinaldirection, said legs begin moved in a radially inward direction toengage said proximal end of said cutting member in said passage of saidfront drive shaft when said operating member is moved in said secondlongitudinal direction.
 49. A handpiece adapter assembly as recited inclaim 47 wherein 47 locking member is disposed in an aperture formed insaid front drive shaft and communicating with said passage of said frontdrive shaft, said locking member being movable in a radially outwarddirection to receive said proximal end Of said cutting member in saidpassage of said front drive shaft when said operating member is moved insaid first longitudinal direction, said locking member being moved in aradially inward direction to protrude through said aperture into saidpassage of said front drive shaft so as to engage said proximal end ofsaid cutting member in said passage of said front drive shaft when saidoperating member is moved in said second longitudinal direction.
 50. Ahandpiece adapter assembly as recited in claim 49 wherein said lockingmember is spherical.
 51. A handpiece adapter assembly as recited inclaim 49 wherein said proximal end of said cutting member has anexternal annular groove and said locking member is received in saidgroove when said operating member is moved in said second longitudinaldirection to lock said cutting member to said front drive shaft.
 52. Asurgical suction rasp for being reciprocatively driven by areciprocating driver to shape anatomical tissue at an operative site ina patient's body comprising an elongate member having a proximal end forbeing removably coupled to a reciprocating driver and having a distalend for being disposed at an operative site, a tissue cutting surface atsaid distal end and a suction passage having an inlet along said tissuecutting surface and having an outlet disposed proximally of said inlet,said tissue cutting surface being configured to abrade and thusly cutanatomical tissue at the operative site when said tissue cutting surfaceis positioned in contact with the anatomical tissue while said elongatemember is reciprocated by the reciprocating driver, said outlet of saidsuction passage being adapted for connection to a source of suctionwhereby anatomical debris is removed from the operative site throughsaid suction passage for withdrawal from the patient's body.
 53. Asurgical suction rasp as recited in claim 52 wherein said tissue cuttingsurface comprises a planar surface having a plurality of sharp ridgesfor abrading bone.
 54. A surgical suction rasp as recited in claim 53wherein said ridges are formed by a plurality of diamond shapedprotuberances on said planar surface.
 55. A surgical suction rasp asrecited in claim 52 wherein said elongate member has a centrallongitudinal axis and said tissue cutting surface is laterally offsetfrom said central longitudinal axis.
 56. A surgical suction rasp asrecited in claim 55 wherein said central longitudinal axis islongitudinally straight and said tissue cutting surface is parallel tosaid central longitudinal axis.
 57. A surgical suction rasp as recitedin claim 55 wherein said central longitudinal axis has a longitudinalcurvature.
 58. A surgical suction rasp as recited in claim 57 whereinsaid longitudinal curvature corresponds to the natural curvature of ahuman frontal bone.
 59. A surgical suction rasp as recited in claim 52wherein said elongate member has a central longitudinal axis, saidtissue cutting surface is disposed on a cutting element at said distalend Of said elongate member and said suction passage extends entirelythrough said cutting element at an angle to said central longitudinalaxis.
 60. A surgical suction rasp as recited in claim 59 wherein saidoutlet is disposed proximally of said distal end of said elongatemember.
 61. A surgical suction rasp as recited in claim 60 wherein saidsuction passage includes a tube extending externally from said cuttingelement alongside said elongate member.
 62. A surgical suction rasp asrecited in claim 61 wherein said tube has a proximal end terminating atsaid outlet and said proximal said of the tube is angled outwardly fromsaid elongate member.
 63. A surgical suction rasp as recited in claim 62wherein said tube has a distal end terminating at said tissue cuttingsurface.
 64. A handpiece adapter assembly for a powered surgicalhandpiece comprising a handpiece adapter for being removably coupledwith a rotatable drive shaft of a powered surgical handpiece and havinga front drive shaft and a motion converting mechanism by which rotarymotion of the drive shaft of the handpiece is converted to reciprocatingmotion of said front drive shaft; and a suction rasp removably coupledto said front drive shaft for being reciprocatively driven thereby andincluding an elongate member having a proximal end removably coupled tosaid front drive shaft, a distal end for being disposed at an operativesite in a patient's body, a tissue cutting surface at said distal endand a suction passage having an inlet along said tissue cutting surfaceand having an outlet disposed proximally of said inlet, said tissuecutting surface having a configuration to abrade and thusly cutanatomical tissue at the operative site when said tissue cutting surfaceis positioned in contact with the anatomical tissue while said elongatemember is reciprocated by said front drive shaft, said outlet of saidsuction passage being adapted for connection to a source of suctionwhereby anatomical debris is removed from the operative site throughsaid suction passage for withdrawal from the patient's body.
 65. Apowered surgical handpiece assembly comprising a powered surgicalhandpiece having a rotatable drive shaft; a handpiece adapter removablycoupled with said rotatable drive shaft and having a front drive shaftand a motion converting mechanism by which rotary motion of saidrotatable drive shaft is converted to reciprocating motion of said frontdrive shaft; and a suction rasp removably coupled to said front driveshaft for being reciprocatively driven thereby and including an elongatemember having a proximal end removably coupled to said front driveshaft, a distal end for being disposed at an operative site in apatient's body, a tissue cutting surface at said distal end and asuction passage having an inlet along said tissue cutting surface andhaving an outlet disposed proximally of said inlet, said tissue cuttingsurface having a configuration to abrade and thusly cut anatomicaltissue at the operative site when said tissue cutting surface ispositioned in contact with the anatomical tissue while said elongatemember is reciprocated by said front drive shaft, said outlet of saidsuction passage being adapted for connection to a source of suctionwhereby anatomical debris is removed from the operative site throughsaid suction passage for withdrawal from the patient's body.
 66. Asurgical osteotome for being reciprocatively driven by a poweredsurgical handpiece to cut anatomical tissue at an operative site in apatient's body comprising an elongate shaft having a distal end andhaving a proximal end configured for coupling with a powered surgicalhandpiece by which said elongate shaft is reciprocated; and a cuttingelement at said distal end including a longitudinal axis and a distallength portion having a lower part and an upper part extending distallyof said lower part, said upper part being defined by an upper surface ofsaid cutting element and by lateral surfaces angled inwardly toward oneanother such that said upper part is of decreasing width in a distaldirection, said lower part being defined by a lower surface of saidcutting element and by lateral surfaces angled inwardly toward oneanother, at a greater angle than said lateral surfaces of said upperpart, such that said lower part is of decreasing width in said distaldirection with said lateral surfaces of said lower part disposedlaterally inwardly of said lateral surfaces of said upper part, saidlateral surfaces of said lower part merging at a transverse cuttingedge, said lateral surfaces of said upper part merging at a blunt tipdisposed distally of said cutting edge, said cutting edge being adaptedto cut anatomical tissue when said cutting element is advanced distallyalong the tissue while being reciprocated, along with said shaft, by thepowered surgical handpiece, said tip leading said cutting element as itis advanced distally along the anatomical tissue.
 67. A surgicalosteotome as recited in claim 66 wherein said cutting edge is transverseto said longitudinal axis.
 68. A surgical osteotome as recited in claim67 wherein said distal length portion is longitudinally straight.
 69. Asurgical osteotome as recited in claim 67 wherein said distal lengthportion is longitudinally angled in a lateral direction.
 70. A surgicalosteotome as recited in claim 69 wherein said distal length portion islongitudinally curved in said lateral direction.
 71. A handpiece adapterassembly for a powered surgical handpiece comprising a handpiece adapterfor being removably coupled with a rotatable drive shaft of a poweredsurgical handpiece and having a front drive shaft and a motionconverting mechanism by which rotary motion of the drive shaft of thehandpiece is converted to reciprocating motion of said front driveshaft; and an osteotome removably coupled to said front drive shaft forbeing reciprocatively driven thereby and including an elongate shafthaving a proximal end removably coupled to said front drive shaft and acutting element at said distal end, said cutting element including alongitudinal axis and a distal length portion having a lower part and anupper part extending distally of said lower part, said upper part beingdefined by an upper surface of said cutting element and by lateralsurfaces, said lower part being defined by a lower surface of saidcutting element and by lateral surfaces disposed laterally inwardly ofsaid lateral surfaces of said upper part, said lower part tapering inwidth in a distal direction such that said lateral surfaces of saidlower part merge at a cutting edge disposed transverse to said axis,said cutting edge being adapted to cut anatomical tissue when saidcutting element is advanced distally along the tissue while beingreciprocated by said front drive shaft, said upper part terminatingdistally at a blunt tip disposed distally of said cutting edge, said tipleading said cutting element as it is advanced distally along thetissue.
 72. A powered surgical handpiece assembly comprising a poweredsurgical handpiece having a rotatable drive shaft; a handpiece adapterremovably coupled with said rotatable drive shaft and having a frontdrive shaft and a motion converting mechanism by which rotary motion ofsaid rotatable drive shaft is converted to reciprocating motion of saidfront drive shaft; and an osteotome removably coupled to said frontdrive shaft for being reciprocatively driven thereby and including anelongate shaft having a proximal end removably coupled to said frontdrive shaft and a cutting element at said distal end, said cuttingelement including a longitudinal axis and a distal length portion havinga lower part and an upper part extending distally of said lower part,said upper part being defined by an upper surface of said cuttingelement and by lateral surfaces, said lower part being defined by alower surface of said cutting element and by lateral surfaces disposedlaterally inwardly of said lateral surfaces of said upper part, saidlower part tapering in width in a distal direction such that saidlateral surfaces of said lower part merge at a cutting edge disposedtransverse to said axis, said cutting edge being adapted to cutanatomical tissue when said cutting element is advanced distally alongthe tissue while being reciprocated by said front drive shaft, saidupper part terminating distally at a blunt tip disposed distally of saidcutting edge, said tip leading said cutting element as it is advanceddistally along the tissue.
 73. A method of surgically reshaping thenasal bone of a patient comprising the steps of introducing a distal endof a surgical suction rasp through an incision in the patient's nose;advancing the rasp along the nose to position the distal end at anoperative site at which an area of the nasal bone is to be reshaped;positioning a tissue cutting surface at the distal end in contact withthe area of the nasal bone that is to be reshaped; reciprocating thedistal end of the rasp to abrade the nasal bone in contact with thetissue cutting surface; moving the distal end of the rasp, while it isbeing reciprocated, along the area of the nasal bone to abrade andthusly reshape the nasal bone; removing anatomical debris from theoperative site through a suction passage of the rasp while the area ofthe nasal bone is being reshaped; and withdrawing the rasp from the noseupon completion of reshaping of the nasal bone.
 74. A method ofsurgically reshaping the nasal bone as recited in claim 73 wherein saidstep of reciprocating includes reciprocating the distal end of the raspwith a powered surgical handpiece.
 75. A method of surgically reshapingthe nasal bone as recited in claim 74 wherein said step of reciprocatingincludes converting rotary motion of a rotatable drive shaft of thepowered surgical handpiece into reciprocating motion of the rasp.
 76. Amethod of surgically reshaping the nasal bone as recited in claim 75 andfurther including, prior to said step of introducing, the steps ofremovably coupling a proximal end of the rasp to a front drive shaft ofa handpiece adapter and removably coupling a rear drive shaft of thehandpiece adapter to the drive shaft of the handpiece, and said step ofconverting includes the steps of rotating the drive shaft of thehandpiece following said step of positioning, rotating the rear driveshaft of the handpiece adapter in response to rotation of the driveshaft of the handpiece, causing a cam of the rear drive shaft toreciprocate a cam follower of the front drive shaft as the rear driveshaft is rotated by the drive shaft of the handpiece such that the frontdrive shaft is reciprocated to reciprocatively drive the rasp.
 77. Amethod of surgically reshaping the nasal bone as recited in claim 76wherein said step of rotating the drive shaft of the handpiece includesrotating the drive shaft of the handpiece at a speed of 5,000 RPM.
 78. Amethod of surgically reshaping the nasal bone as recited in claim 76wherein said step of rotating the drive shaft of the handpiece includesrotating the rotatable drive shaft of the handpiece with an electricmotor of the handpiece.
 79. A method of surgically reshaping the nasalbone as recited in claim 78 wherein said step of moving includesmanipulating the handpiece to move the tissue cutting surfacelongitudinally and laterally along the area of the nasal bone while thedistal end is being reciprocated.
 80. A method of surgically reshapingthe nasal bone as recited in claim 73 wherein said step of removingincludes drawing th e anatomical debris into the suction passage throughan inlet opening of the suction passage disposed on the tissue cuttingsurface.
 81. A method of surgically reshaping the nasal bone as recitedin claim 80 wherein said step of removing includes transporting theanatomical debris through an outlet opening of the suction passagedisposed external of the patient's nose.
 82. A method of surgicallyreshaping the nasal bone as recited in claim 73 and further includingthe step of confirming proper reshaping of the nasal bone.
 83. A methodof surgically reshaping the nasal bone as recited in claim 82 whereinsaid step of confirming includes palpating the patient's nose.
 84. Amethod of surgically reshaping the nasal bone as recited in claim 73wherein said step of reciprocating includes reciprocating the distal endof the rasp in a stroke of 3.0 mm.
 85. A method of making a cut in thenasal bone of a patient in a rhinoplasty procedure comprising the stepsof removably coupling a proximal end of an osteotome to a poweredsurgical handpiece; introducing a distal end of the osteotome through anincision in the patient's nose; advancing the osteotome along the noseto position a cutting edge carried by the distal end at a location onthe nasal bone at which a cut is to be made; reciprocating the distalend of the osteotome via the powered surgical handpiece; moving thedistal end of the osteotome, while it is being reciprocated, forwardlyalong the nasal bone in a predetermined path with the cutting edge incontact with the nasal bone to make a cut of desired length in the nasalbone along the predetermined path; and withdrawing the osteotome fromthe nose upon completion of the cut being made.
 86. A method of making acut as recited in claim 85 wherein said step of reciprocating includesconverting rotary motion of a rotatable drive shaft of the poweredsurgical handpiece into reciprocating motion of the osteotome.
 87. Amethod of making a cut as recited in claim 86 wherein said step ofremovably coupling includes the steps of removably coupling the proximalend of the osteotome to a front drive shaft of a handpiece adapter andremovably coupling a rear drive shaft of the handpiece adapter to thedrive shaft of the handpiece, and said step of converting includes thesteps of rotating the drive shaft of the handpiece following said stepof advancing, rotating the rear drive shaft of-the handpiece adapter inresponse to rotation of the drive shaft of the handpiece, causing a camof the rear drive shaft to reciprocate a cam follower of the front driveshaft as the rear drive shaft is rotated by the drive shaft of thehandpiece such that the front drive shaft is reciprocated toreciprocatively drive the osteotome.
 88. A method of making a cut asrecited in claim 87 wherein said step of rotating the drive shaft of thehandpiece includes rotating the drive shaft of the handpiece at a speedof 6,000 RPM.
 89. A method of making a cut as recited in claim 87wherein said step of rotating the drive shaft of the handpiece includesrotating the drive shaft of the handpiece with an electric motor of thehandpiece.
 90. A method of making a cut as recited in claim 85 whereinsaid step of moving includes manipulating the handpiece to move thedistal end of the osteotome forwardly along the nasal bone in thepredetermined path.
 91. A method of making a cut as recited in claim 90wherein said step of moving includes moving the distal end of theosteotome forwardly along the nasal bone in a straight predeterminedpath to form a longitudinally straight cut in the nasal bone.
 92. Amethod of making a cut as recited in claim 90 wherein said step ofmoving includes moving the distal end of the osteotome forwardly alongthe nasal bone in a curved predetermined path to form a longitudinallycurved cut in the nasal bone.
 93. A method of making a cut as recited inclaim 85 wherein said step of removably coupling includes removablycoupling the proximal end of a first osteotome having a longitudinallystraight distal length portion to the powered surgical handpiece andsaid step of moving includes moving the distal end of the firstosteotome longitudinally along the nasal bone in a straightpredetermined path to make a straight medial cut in the nasal bone. 94.A method of making a cut as recited in claim 93 and further including,subsequent to said step of withdrawing, the step of removably couplingthe proximal end of a second osteotome having a laterally curved distallength portion to the powered surgical handpiece, introducing the distalend of the second osteotome through the incision, advancing the secondosteotome along the nose to position a cutting edge carried by thedistal end of the second osteotome at a location on the nasal bone atwhich a curved lateral cut is to be made, reciprocating the distal endof the second osteotome via the powered surgical handpiece, moving thedistal end of the second osteotome, while it is being reciprocated,forwardly along the nasal bone in a predetermined curved path, laterallyspaced from the medial cut, with the cutting edge of the secondosteotome in contact with the nasal bone to make a curved lateral cut ofdesired length in the nasal bone along the predetermined curved path andwithdrawing the second osteotome from the nose upon completion of thelateral cut being made.
 95. A method of making a cut as recited in claim94 and further including, prior to said steps of introducing, the stepof marking the skin of the patient's nose overlying the nasal bone toindicate the locations and the predetermined paths for the medial andlateral cuts, respectively.
 96. A method of making a cut as recited inclaim 85 and further including the step of confirming proper formationof the cut.
 97. A method of making a cut as recited in claim 96 whereinsaid step of confirming includes palpating the patient's nose.
 98. Amethod of making a cut as recited in claim 85 wherein said step ofreciprocating includes reciprocating the distal end of the osteotome ina stroke of 2.0 mm.
 99. A method of making a cut as recited in claim 85and further including, to said step of withdrawing, the steps ofintroducing a distal end of a surgical suction rasp through theincision, advancing the rasp along the nose to position the distal endof the rasp at an operative site at which an area of the nasal bone isto be contoured positioning a tissue cutting surface at the distal endof the rasp in contact with the area of the nasal bone that is to becontoured, reciprocating the distal end of the rasp to abrade the nasalbone with the tissue cutting surface whereby the nasal bone iscontoured, removing anatomical debris from the operative site through asuction passage of the rasp while the area of the nasal bone is beingcontoured and withdrawing the rasp from the nose upon completion of thecontouring of the nasal bone.